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Utah rates for HCPCS D0120

Periodic Oral Evaluation

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$16.10 / $16.10 / $16.10
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.31 / $16.10 / $19.98
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $45.00 / $60.00