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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
$15.85 / $15.85 / $15.85
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.88 / $15.85 / $40.74
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14.79 / $380.19 / $5,754.40
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$64.57 / $79.43 / $79.43
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14.45 / $18.20 / $30.20
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$109.65 / $109.65 / $109.65