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Washington rates for HCPCS D0367

cone beam CT capture and interpretation with field of view of both jaws; with or without cranium

Facilitymedian $407 · 10th–90th $245–$5250%20%10th90th$407Professionalmedian $186 · 10th–90th $135–$2240%10%20%10th90th$186$50.0$100.0$200.0$500.0

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$199.53 / $199.53 / $199.53
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$134.90 / $186.21 / $223.87
Kaiser Permanente
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$316.23 / $446.68 / $524.81
Kaiser Permanente
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$316.23 / $446.68 / $524.81
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$44.67 / $50.12 / $75.86
Pacific Source
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$245.47 / $407.38 / $407.38
Premera BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$616.60 / $616.60 / $616.60