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Wisconsin rates for HCPCS D0367

Cone Beam Ct Capture & Interp Fd View Both Jaws

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$162.29 / $162.29 / $162.29
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$147.74 / $162.29 / $224.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$156.10 / $332.55 / $719.33
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$144.07 / $191.81 / $356.05
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$149.58 / $194.99 / $431.89
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,066.36 / $1,066.36 / $1,066.36
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.00 / $58.40 / $559.60
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$137.05 / $174.71 / $356.05
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$264.76 / $485.90 / $677.60
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$391.22 / $1,075.93 / $1,075.93
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$880.25 / $1,066.36 / $1,066.36