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Connecticut rates for HCPCS D0120

Periodic Oral Evaluation

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.88 / $17.07 / $39.02
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.25 / $27.00 / $52.50
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.22 / $19.22 / $19.22
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.00 / $23.00 / $29.00