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Alaska 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
Professional
Modifier
Low / Median / High Price
$530.41 / $530.41 / $530.41
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$530.41 / $742.59 / $758.50
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$404.65 / $404.65 / $578.08
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,088.00 / $1,088.00 / $1,088.00
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$530.41 / $742.59 / $758.50
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$404.65 / $1,088.00 / $2,250,000.00