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Texas rates for HCPCS D0120

Periodic Oral Evaluation - Established Patient

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$13.84 / $15.03 / $15.03
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.15 / $15.54 / $19.64
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.45 / $25.23 / $25.23
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$80.00 / $80.00 / $80.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.22 / $19.22 / $19.22
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$32.09 / $86.18 / $86.18
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$108.59 / $108.59 / $139.05
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14.12 / $18.25 / $29.64
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.13 / $16.13 / $16.13
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$26.00 / $28.50 / $28.50
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14.12 / $18.26 / $29.70
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$27.50 / $2,250,000.00 / $2,400,000.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$31.00 / $31.00 / $65.00
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$27.00 / $27.00 / $37.79