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Texas 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
$125.89 / $128.82 / $134.90
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.89 / $173.78 / $245.47
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$79.43 / $79.43 / $79.43
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,096.48 / $1,096.48 / $1,096.48
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,047.13 / $1,737.80 / $1,737.80
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$128.82 / $186.21 / $338.84
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.89 / $151.36 / $223.87
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.20 / $30.20 / $30.20
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.60 / $389.05 / $389.05
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$128.82 / $190.55 / $331.13
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.43 / $194.98 / $245.47
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$302.00 / $302.00 / $371.54