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Rhode Island rates for HCPCS D0120

Periodic Oral Evaluation - Established Patient

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$24.15 / $24.15 / $24.15
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.31 / $23.41 / $39.02
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$262.69 / $262.69 / $291.88
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.22 / $19.22 / $19.22
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.00 / $46.00 / $57.00