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Utah rates for HCPCS D4263

Bone Repl Graft - Ret Nat Tooth - 1st Site Quad

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$159.87 / $159.87 / $159.87
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$159.87 / $177.43 / $194.16
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $45.00 / $258.11