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Montana rates for HCPCS D0120

Periodic Oral Evaluation - Established Patient

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.31 / $18.07 / $19.87
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$68,099.99 / $68,099.99 / $81,499.99
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$27.00 / $27.00 / $27.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.22 / $19.22 / $19.22
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14.31 / $20.53 / $30.99
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17.88 / $27.50 / $2,400,000.00