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Utah rates for HCPCS D0120

Periodic Oral Evaluation - Established Patient

Facilitymedian $16 · 10th–90th $16–$160%50%100%$16Professionalmedian $17 · 10th–90th $13–$340%10%20%10th90th$17$10.0$20.0$50.0

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Small sample — interpret with caution. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$15.85 / $15.85 / $15.85
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$12.88 / $15.85 / $34.67
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$30.20 / $44.67 / $54.95
Select Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$28.18 / $28.84 / $28.84
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$19.05 / $23.44 / $25.12