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Indiana rates for HCPCS D0367

cone beam CT capture and interpretation with field of view of both jaws; with or without cranium

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$144.54 / $144.54 / $407.38
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.89 / $169.82 / $223.87
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$81.28 / $323.59 / $426.58
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$81.28 / $81.28 / $134.90
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$45.71 / $75.86 / $75.86