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Massachusetts rates for HCPCS D0120

Periodic Oral Evaluation - Established Patient

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$23.41 / $23.41 / $23.41
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.10 / $17.38 / $39.02
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14.69 / $73.44 / $86.18
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$18.76 / $42.12 / $108.59
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$37.06 / $44.17 / $46.28
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.22 / $19.22 / $19.22
Fallon Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.39 / $22.97 / $27.02
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$28.87 / $54.37 / $71.90
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$32.09 / $86.18 / $86.18
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$108.59 / $108.59 / $108.59
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$27.00 / $32.00 / $50.00