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Pennsylvania rates for HCPCS D0120

Periodic Oral Evaluation

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14.10 / $3,014.23 / $3,045.83
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.54 / $15.39 / $20.00
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8,459.92 / $8,639.91 / $79,506.39
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17.13 / $17.77 / $17.77
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.22 / $19.22 / $19.22
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$273.58 / $273.58 / $922.62
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14.10 / $3,014.23 / $5,628.17
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.84 / $16.61 / $22.62
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$26.00 / $28.50 / $28.50
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.22 / $19.22 / $19.22
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$25.00 / $30.00 / $50.00