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Wisconsin rates for HCPCS D0367

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

Facilitymedian $229 · 10th–90th $155–$5890%20%10th90th$229Professionalmedian $191 · 10th–90th $135–$4900%10%10th90th$191$100.0$200.0$500.0$1.0K$2.0K

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
$162.18 / $162.18 / $162.18
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$134.90 / $173.78 / $223.87
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$154.88 / $323.59 / $602.56
DeanCare
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$154.88 / $363.08 / $549.54
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$144.54 / $194.98 / $436.52
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,071.52 / $1,071.52 / $1,071.52
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$50.12 / $54.95 / $70.79
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$269.15 / $489.78 / $691.83
Quartz
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$389.05 / $1,096.48 / $1,096.48
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$851.14 / $1,047.13 / $1,047.13