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Minnesota rates for HCPCS D0120

Periodic Oral Evaluation - Established Patient

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$16.94 / $16.94 / $16.94
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.54 / $16.94 / $19.87
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14.66 / $304.88 / $3,041.03
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$64.00 / $77.59 / $80.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.83 / $14.83 / $19.22
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15.39 / $23.78 / $34.81
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$28.19 / $108.59 / $108.59