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Washington rates for HCPCS D0120

Periodic Oral Evaluation - Established Patient

Facilitymedian $23 · 10th–90th $15–$420%10%10th90th$23Professionalmedian $17 · 10th–90th $13–$430%10%20%10th90th$17$10.0$20.0$50.0$100.0$200.0$500.0$1.0K

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$19.95 / $19.95 / $19.95
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$12.88 / $16.98 / $40.74
Kaiser Permanente
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$14.45 / $22.91 / $42.66
Kaiser Permanente
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$14.45 / $21.88 / $38.02
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$44.67 / $50.12 / $75.86
Pacific Source
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$28.18 / $33.88 / $33.88
Premera BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$48.98 / $48.98 / $48.98