go back

Maine rates for HCPCS D0120

Periodic Oral Evaluation - Established Patient

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$27.79 / $27.79 / $27.79
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.44 / $19.46 / $27.79
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$22.84 / $32.20 / $38.18
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$28.87 / $33.40 / $60.12
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.92 / $23.41 / $33.34
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.00 / $44.00 / $57.00