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Virginia rates for HCPCS D0120

Periodic Oral Evaluation - Established Patient

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14.89 / $19.64 / $19.64
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.84 / $16.39 / $19.64
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$28.75 / $29.50 / $42.08
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.00 / $35.00 / $62.40
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.22 / $19.22 / $19.22
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.10 / $20.12 / $29.26
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14.30 / $19.64 / $29.93
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$22.00 / $31.00 / $40.18
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$16.20 / $19.43 / $29.49
Sentara
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.45 / $19.43 / $34.22
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.00 / $26.00 / $34.00