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North Dakota rates for HCPCS D0120

Periodic Oral Evaluation

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$17.67 / $17.67 / $17.67
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.84 / $17.67 / $19.87
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$41.13 / $48.39 / $53.23
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.22 / $19.22 / $19.22
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$16.57 / $21.11 / $29.14
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$108.59 / $108.59 / $108.59