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Utah rates for HCPCS D7220

Removal Of Impacted Tooth - Soft Tissue

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$112.20 / $112.20 / $112.20
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$107.15 / $125.89 / $257.04
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.20 / $44.67 / $194.98
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$173.78 / $177.83 / $177.83
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$165.96 / $186.21 / $204.17