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New York rates for HCPCS D0120

Periodic Oral Evaluation - Established Patient

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11.88 / $14.10 / $66.09
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.88 / $15.39 / $20.53
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.37 / $20.32 / $30.62
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.22 / $19.22 / $19.22
Excellus BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$16.80 / $16.80 / $16.80
Excellus BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$25.25 / $36.22 / $36.22
MVP Health Care
Facility/Professional
Facility
Modifier
Low / Median / High Price
$555.00 / $555.00 / $597.00
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$18.55 / $19.22 / $29.54
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$24.00 / $32.00 / $38.92
Univera
Facility/Professional
Facility
Modifier
Low / Median / High Price
$16.48 / $16.48 / $16.48
Univera
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.48 / $36.22 / $36.22