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Indiana rates for HCPCS D0120

Periodic Oral Evaluation

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12.29 / $12.29 / $24.77
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.29 / $15.03 / $18.07
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.00 / $25.00 / $31.74
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.83 / $20.13 / $20.13
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$34.00 / $35.00 / $36.00