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Oklahoma 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
$121.97 / $121.97 / $121.97
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$123.40 / $154.34 / $206.97
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$121.97 / $128.07 / $1,075.93
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$165.95 / $1,066.36 / $1,066.36