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South Carolina rates for HCPCS D0120

Periodic Oral Evaluation

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.44 / $15.07 / $19.64
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$165.38 / $165.38 / $165.38
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.38 / $23.38 / $49.92
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.22 / $19.22 / $19.22
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15.07 / $15.82 / $25.62
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.24 / $15.24 / $15.45
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$55.00 / $1,500.00 / $3,000.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$25.00 / $33.00 / $42.00