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Ohio rates for HCPCS 0634T

Computed tomography, breast, including 3D rendering, when performed, unilateral; with contrast material(s)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$436.52 / $794.33 / $1,288.25
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$173.78 / $208.93 / $302.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$158.49 / $204.17 / $338.84
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$186.21 / $1,862.09 / $41,686.94
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$245.47 / $2,454.71 / $5,495.41
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$131.83 / $131.83 / $309.03
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$239.88 / $275.42 / $933.25
Medical Mutual of Ohio
Facility/Professional
Facility
Modifier
Low / Median / High Price
$131.83 / $309.03 / $398.11
Medical Mutual of Ohio
Facility/Professional
Professional
Modifier
Low / Median / High Price
$239.88 / $302.00 / $933.25
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.81 / $50.12 / $60.26
SummaCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$213.80 / $213.80 / $213.80
SummaCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.12 / $70.79 / $75.86
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$134.90 / $173.78 / $416.87
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$141.25 / $181.97 / $331.13