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Pennsylvania 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
$123.80 / $141.40 / $141.40
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$123.80 / $154.34 / $224.00
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$141.40 / $141.40 / $141.40
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$123.80 / $154.34 / $224.00
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$325.00 / $325.00 / $325.00