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
$31
Average
$1.4k
Median
$132
High
$22k
Each hospital's average Medicare rate, under the methodology and billing class chosen below.
26 hospitals; the 90th percentile is 86.9× 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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26 hospital rates
iThe hospitals that file a Medicare 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 | BAPTIST HOSPITAL OF MIAMI PLANTATION, FL fee schedule · both | 2 | $163 | $163 | $24 | 15% | — | $139 – $188 |
| 2 | Bon Secours Community Hospital Jervis, NY facility · fee schedule · outpatient | 1 | $166 | $166 | — | — | — | $166 – $166 |
| 3 | Boston Medical Center Boston, MA other · both | 1 | $155 | $155 | — | — | — | $155 – $155 |
| 4 | Good Samaritan Hospital Suffern, NY facility · fee schedule · outpatient | 1 | $3.5k | $3.5k | — | — | — | $3.5k – $3.5k |
| 5 | Grady Memorial Hospital Atlanta, GA facility · case rate · outpatient | 1 | $128 | $128 | — | — | — | $128 – $128 |
| 6 | HealthAlliance Hospital Kingston, NY facility · fee schedule · outpatient | 1 | $5.5k | $5.5k | — | — | — | $5.5k – $5.5k |
| 7 | MVHS, Inc. Utica, NY other · outpatient | 1 | $166 | $166 | — | — | — | $166 – $166 |
| 8 | Margaretville Memorial Hospital Margaretville, NY facility · fee schedule · outpatient | 1 | $22k | $22k | — | — | — | $22k – $22k |
| 9 | Mid Hudson Regional Hospital Poughkeepsie, NY facility · fee schedule · outpatient | 1 | $2.1k | $2.1k | $1.9k | 92% | — | $165 – $3.9k |
| 10 | PRISMA HEALTH BAPTIST EASLEY HOSPITAL EASLEY, SC other · both | 1 | $126 | $126 | — | — | — | $126 – $126 |
| 11 | PRISMA HEALTH BLOUNT MEMORIAL HOSPITAL MARYVILLE, TN other · both | 1 | $126 | $126 | — | — | — | $126 – $126 |
| 12 | PRISMA HEALTH GREENVILLE MEMORIAL HOSPITAL GREENVILLE, SC other · both | 1 | $126 | $126 | — | — | — | $126 – $126 |
| 13 | PRISMA HEALTH GREER MEMORIAL HOSPITAL GREER, SC other · both | 1 | $127 | $127 | — | — | — | $127 – $127 |
| 14 | PRISMA HEALTH HILLCREST HOSPITAL SIMPSONVILLE, SC other · both | 1 | $127 | $127 | — | — | — | $127 – $127 |
| 15 | PRISMA HEALTH LAURENS COUNTY HOSPITAL CLINTON, SC other · both | 1 | $135 | $135 | — | — | — | $135 – $135 |
| 16 | PRISMA HEALTH NORTH GREENVILLE LTACH HOSPITAL TRAVELERS REST, SC other · both | 1 | $128 | $128 | — | — | — | $128 – $128 |
| 17 | PRISMA HEALTH OCONEE MEMORIAL HOSPITAL SENECA, SC other · both | 1 | $136 | $136 | — | — | — | $136 – $136 |
| 18 | PRISMA HEALTH PATEWOOD HOSPITAL GREENVILLE, SC other · both | 1 | $127 | $127 | — | — | — | $127 – $127 |
| 19 | St Anthony Community Hospital Warwick, NY facility · fee schedule · outpatient | 1 | $166 | $166 | — | — | — | $166 – $166 |
| 20 | ThedaCare Regional Medical Center-Berlin Inc WI 54971-9286; N2930 State Rd 22 Wautoma, WI facility · percent of total billed charges · outpatientfrom % of charges | 1 | $31 | $31 | $0 | 2% | — | $30 – $31 |
| 21 | Thedacare Regional Medical Center-New London Inc WI 54961; 370 S. Main St. Clintonville, WI facility · percent of total billed charges · outpatientfrom % of charges | 1 | $36 | $36 | $1 | 1% | — | $36 – $37 |
| 22 | Thedacare Regional Medical Center-Shawano Inc Shawano, WI facility · percent of total billed charges · outpatientfrom % of charges | 1 | $31 | $31 | $0 | 2% | — | $30 – $31 |
| 23 | Thedacare Regional Medical Center-Waupaca Inc Waupaca, WI facility · percent of total billed charges · outpatientfrom % of charges | 1 | $33 | $33 | $1 | 2% | — | $32 – $33 |
| 24 | Thedacare Regional Medical Center-Wild Rose Inc Wild Rose, WI facility · percent of total billed charges · outpatientfrom % of charges | 1 | $31 | $31 | $0 | 2% | — | $30 – $31 |
| 25 | UMass Memorial Medical Center MA 01605; 157 Union Street Marlborough, MA other · both | 1 | $160 | $160 | — | — | — | $160 – $160 |
← Payers reporting HCPCS D0120 · Snapshot 20261111T120946Z-9134e7f7