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South Dakota rates for HCPCS D0120

Periodic Oral Evaluation

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$16.94 / $16.94 / $16.94
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.38 / $16.94 / $19.87
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.22 / $19.22 / $19.22
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$16.57 / $28.00 / $33.40
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 / $29.02 / $39.83
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.24 / $28.19 / $36.34
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.29 / $40.29 / $40.29