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Utah rates for HCPCS 0636T

Computed tomography, breast, including 3D rendering, when performed, bilateral; without contrast material(s)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$218.78 / $2,187.76 / $2,884.03
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$169.82 / $208.93 / $275.42
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$389.05 / $575.44 / $602.56
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$338.84 / $371.54 / $416.87
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.20 / $30.20 / $60.26
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$380.19 / $446.68 / $1,000.00
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$208.93 / $229.09 / $338.84
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$275.42 / $309.03 / $323.59
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$93.33 / $151.36 / $269.15
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$199.53 / $199.53 / $389.05