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Utah rates for HCPCS D4273

Autogenous Connective Tissue Graft Procedure (Including Donor And Recipient Surgical Sites) First Tooth, Implant, Or Edentulous Tooth Position In Graft

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$389.05 / $389.05 / $389.05
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$302.00 / $363.08 / $436.52
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.20 / $44.67 / $602.56
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$524.81 / $537.03 / $537.03
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$436.52 / $489.78 / $537.03