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Louisiana rates for HCPCS D0120

Periodic Oral Evaluation

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15.04 / $15.04 / $15.39
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.33 / $16.96 / $19.98
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$24.60 / $28.31 / $28.88
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.22 / $19.22 / $19.22
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$26.00 / $26.00 / $29.00