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North Carolina rates for HCPCS D0120

Periodic Oral Evaluation - Established Patient

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$17.07 / $17.07 / $17.07
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.17 / $17.07 / $19.64
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$18.57 / $32.11 / $45.00
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15.24 / $17.07 / $27.33
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.67 / $22.00 / $24.00
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.80 / $26.00 / $28.50
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$31.88 / $39.00 / $51.00
Wellcare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$32.09 / $86.18 / $86.18
Wellcare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$108.59 / $139.05 / $139.05