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California rates for HCPCS D0120

Periodic Oral Evaluation - Established Patient

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$16.93 / $18.07 / $18.07
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.98 / $16.93 / $20.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17.64 / $25.00 / $32.20
Blue Shield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$22.40 / $32.00 / $80.02
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.22 / $19.22 / $19.22
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$283.26 / $638.07 / $801.00
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$32.09 / $86.18 / $86.18
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$108.59 / $108.59 / $139.05
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$24.48 / $60.00 / $85.00
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15.39 / $21.39 / $28.01
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.75 / $2,250,000.00 / $2,400,000.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$31.00 / $46.00 / $62.00