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Missouri rates for HCPCS D0120

Periodic Oral Evaluation - Established Patient

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.10 / $16.35 / $19.57
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.72 / $19.61 / $29.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.22 / $19.22 / $19.22
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15.93 / $20.21 / $39.15
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17.01 / $108.59 / $108.59