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Kentucky rates for HCPCS D0120

Periodic Oral Evaluation - Established Patient

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$16.42 / $16.42 / $16.42
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.10 / $16.42 / $19.87
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.00 / $28.75 / $29.50
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.22 / $19.22 / $19.22
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.00 / $45.00 / $3,000.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$28.00 / $32.00 / $34.00