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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
$239.62 / $239.62 / $239.62
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$239.62 / $239.62 / $326.49
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.00 / $45.00 / $458.76