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Utah rates for HCPCS D4261

Osseous Surgery (Including Elevation Of A Full Thickness Flap And Closure) - One To Three Contiguous Teeth Or Tooth Bounded Spaces Per Quadrant

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$239.88 / $239.88 / $239.88
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$186.21 / $245.47 / $269.15
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.20 / $44.67 / $416.87
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$371.54 / $380.19 / $380.19
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$331.13 / $363.08 / $407.38