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Maine 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
Professional
Modifier
Low / Median / High Price
$183.30 / $224.00 / $258.05
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$134.87 / $300.00 / $300.00
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$183.30 / $224.00 / $258.05