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Minnesota 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
$208.93 / $208.93 / $208.93
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$123.03 / $173.78 / $223.87
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$173.78 / $407.38 / $794.33
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$588.84 / $741.31 / $741.31
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$134.90 / $245.47 / $380.19
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,071.52 / $1,071.52 / $1,071.52