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South Dakota 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
$204.17 / $204.17 / $1,819.70
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$186.21 / $223.87 / $275.42
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$263.03 / $323.59 / $446.68
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$181.97 / $275.42 / $457.09
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$229.09 / $229.09 / $229.09
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$190.55 / $275.42 / $389.05