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Utah rates for HCPCS D4273

Autogenous Connective Tissue Graft Procedure

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$387.66 / $387.66 / $387.66
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$364.27 / $387.66 / $479.01
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.00 / $45.00 / $655.36