go back

Maryland rates for HCPCS D0120

Periodic Oral Evaluation - Established Patient

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.94 / $15.07 / $20.53
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$28.80 / $32.00 / $50.88
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
$15.55 / $20.12 / $28.09
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.00 / $23.00 / $75.00
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$27.00 / $27.00 / $27.00