Hospitals report these codes with terse, inconsistent chargemaster text. This plain-English title was written by an AI model from that text and has not been reviewed by a person, so it can be wrong. The prices on this page come straight from hospital filings and do not depend on it.
Original text from hospital filings
PERIODIC ORAL EVALUATION - ESTABLISHED PATIENT
Low
$11
Average
$340
Median
$139
High
$27.3k
Each hospital's average Aetna rate, under the methodology and billing class chosen below.
550 hospitals; the 90th percentile is 2.5× the 10th. Each bar is a price range and its height is how many hospitals fall in it. Hover a bar, or a row in the ladder, for details.
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640 hospital rates
iThe hospitals that file a Aetna rate for this code, one row per hospital and set of terms (billing class, payment method, setting). Rates under different terms are never blended, so the terms are shown under each hospital’s name. Figures are the hospital’s averages across its plans.| # | Plans | |||||||
|---|---|---|---|---|---|---|---|---|
| 1 | Arkansas Childrens Hospital Little Rock, AR facility · percent of total billed charges · outpatientfrom % of charges | 1 | $55 | $55 | — | — | 1–10 | $55 – $55 |
| 2 | PRISMA HEALTH BAPTIST EASLEY HOSPITAL EASLEY, SC percent of total billed charges · bothfrom % of charges | 2 | $254 | $238 | $23 | 10% | 1–10 | $206 – $254 |
| 3 | PRISMA HEALTH GREENVILLE MEMORIAL HOSPITAL GREENVILLE, SC percent of total billed charges · bothfrom % of charges | 2 | $254 | $238 | $23 | 10% | 1–10 | $206 – $254 |
| 4 | ADVENTIST HEALTH CLEARLAKE HOSPITAL INC Clearlake, CA percent of total billed charges · outpatientfrom % of charges | 1 | $55 | $55 | — | — | — | $55 – $55 |
| 5 | ADVENTIST HEALTH MEDICAL CENTER TEHACHAPI Tehachapi, CA fee schedule · outpatient | 1 | $19 | $19 | — | — | — | $19 – $19 |
| 6 | ADVENTIST HEALTH MEDICAL CENTER TEHACHAPI Tehachapi, CA percent of total billed charges · outpatientfrom % of charges | 1 | $45 | $45 | — | — | — | $45 – $45 |
| 7 | AKRON GENERAL MEDICAL CENTER Akron, OH facility · fee schedule · outpatient | 1 | $126 | $126 | — | — | — | $126 – $126 |
| 8 | AKRON GENERAL MEDICAL CENTER Akron, OH professional · percent of total billed charges · outpatientfrom % of charges | 3 | $76 | $81 | $10 | 13% | — | $71 – $95 |
| 9 | ALBANY MEDICAL CENTER HOSPITAL Albany, NY facility · fee schedule · outpatient | 2 | $239 | $239 | $79 | 33% | — | $160 – $319 |
| 10 | ALLE-KISKI MEDICAL CENTER NATRONA HEIGHTS, PA fee schedule · outpatient | 3 | $313 | $406 | $272 | 67% | — | $129 – $776 |
| 11 | Acadia Hospital Bangor, ME facility · case rate · outpatient | 1 | $127 | $127 | — | — | — | $127 – $127 |
| 12 | Acadia Hospital Bangor, ME professional · fee schedule · outpatient | 1 | $28 | $28 | — | — | — | $28 – $28 |
| 13 | AdventHealth Avista Louisville, CO fee schedule · outpatient | 1 | $142 | $142 | — | — | — | $142 – $142 |
| 14 | AdventHealth Deland Deland, FL fee schedule · outpatient | 1 | $149 | $149 | — | — | — | $149 – $149 |
| 15 | AdventHealth Littleton Littleton, CO fee schedule · outpatient | 1 | $140 | $140 | — | — | — | $140 – $140 |
| 16 | AdventHealth New Smyrna Beach New Smyrna Beach, FL fee schedule · outpatient | 1 | $149 | $149 | — | — | — | $149 – $149 |
| 17 | AdventHealth Orlando Winter Park, FL fee schedule · outpatient | 1 | $149 | $149 | — | — | — | $149 – $149 |
| 18 | AdventHealth Parker Aurora, CO fee schedule · outpatient | 1 | $140 | $140 | — | — | — | $140 – $140 |
| 19 | AdventHealth Porter Denver, CO fee schedule · outpatient | 1 | $140 | $140 | — | — | — | $140 – $140 |
| 20 | Adventhealth Carrollwood Tampa, FL fee schedule · outpatient | 1 | $145 | $145 | — | — | — | $145 – $145 |
| 21 | Adventhealth Daytona Beach Port Orange, FL fee schedule · outpatient | 1 | $149 | $149 | — | — | — | $149 – $149 |
| 22 | Adventhealth Fish Memorial Deltona, FL fee schedule · outpatient | 1 | $149 | $149 | — | — | — | $149 – $149 |
| 23 | Adventhealth Gordon Calhoun, GA fee schedule · outpatient | 1 | $138 | $138 | — | — | — | $138 – $138 |
| 24 | Adventhealth Heart of Florida Winter Haven, FL fee schedule · outpatient | 1 | $149 | $149 | — | — | — | $149 – $149 |
| 25 | Adventhealth Hendersonville Hendersonville, NC fee schedule · outpatient | 1 | $127 | $127 | — | — | — | $127 – $127 |
← Payers reporting HCPCS D0120 · Snapshot 20261111T120946Z-9134e7f7