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Wisconsin 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
$200.00 / $200.00 / $385.86
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$192.55 / $211.49 / $385.86
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$192.93 / $435.36 / $1,326.80
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$218.68 / $275.27 / $531.97
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$218.68 / $336.49 / $1,063.66
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$244.92 / $552.16 / $1,293.17
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.00 / $65.00 / $70.00
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$218.68 / $275.08 / $518.53
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$324.00 / $462.78 / $660.00
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$501.12 / $2,489.36 / $2,489.36
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$858.51 / $1,293.17 / $1,293.17
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$234.99 / $528.73 / $969.10