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New York 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
$181.97 / $181.97 / $223.87
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$123.03 / $181.97 / $239.88
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$81.28 / $134.90 / $275.42
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$50,118.72 / $50,118.72 / $53,703.18
Excellus BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$165.96 / $194.98 / $281.84
MVP Health Care
Facility/Professional
Facility
Modifier
Low / Median / High Price
$50,118.72 / $53,703.18 / $75,857.76
Univera
Facility/Professional
Facility
Modifier
Low / Median / High Price
$165.96 / $194.98 / $194.98
Univera
Facility/Professional
Professional
Modifier
Low / Median / High Price
$165.96 / $194.98 / $281.84