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Iowa 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
$272.30 / $342.09 / $342.09
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$150.00 / $1,353.25 / $1,734.76
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$416.65 / $699.37 / $1,300.32
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$540.99 / $830.70 / $2,390.37
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$472.50 / $837.20 / $1,314.76
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$472.50 / $659.29 / $978.81
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$815.00 / $815.00 / $815.00