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Utah rates for HCPCS D7250

Removal Of Residual Tooth Roots (Cutting Procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$95.50 / $95.50 / $95.50
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$91.20 / $107.15 / $138.04
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.20 / $44.67 / $162.18
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$141.25 / $147.91 / $147.91
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$144.54 / $162.18 / $177.83