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Nebraska rates for HCPCS D0120

Periodic Oral Evaluation - Established Patient

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$13.17 / $13.17 / $13.17
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.17 / $15.93 / $19.87
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$267.87 / $299.57 / $299.57
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$35.56 / $37.43 / $37.43
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.22 / $19.22 / $19.22
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$13.17 / $22.26 / $41.21
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$28.19 / $108.59 / $108.59
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$21.26 / $28.00 / $43.32
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.26 / $28.33 / $43.32
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.80 / $21.80 / $28.50
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$27.00 / $29.00 / $31.00