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Wisconsin rates for HCPCS D0120

Periodic Oral Evaluation - Established Patient

Facilitymedian $17 · 10th–90th $13–$350%10%10th90th$17Professionalmedian $17 · 10th–90th $13–$440%10%20%10th90th$17$10.0$20.0$50.0$100.0$200.0

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
$12.88 / $12.88 / $12.88
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$12.02 / $15.14 / $38.02
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$16.98 / $25.70 / $52.48
DeanCare
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$13.49 / $16.98 / $33.88
DeanCare
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$12.30 / $12.30 / $12.30
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$13.49 / $17.38 / $34.67
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$109.65 / $109.65 / $109.65
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$50.12 / $60.26 / $70.79
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$19.05 / $38.02 / $56.23
Quartz
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$32.36 / $32.36 / $109.65
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$87.10 / $109.65 / $109.65
Security Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$30.20 / $31.62 / $35.48