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Arizona rates for HCPCS D0120

Periodic Oral Evaluation - Established Patient

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14.31 / $14.31 / $14.31
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.84 / $15.54 / $19.77
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.83 / $14.83 / $19.22
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14.31 / $17.45 / $30.28
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$108.59 / $108.59 / $108.59