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Indiana rates for HCPCS D4273

Autogenous Connective Tissue Graft Procedure

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$257.64 / $257.64 / $257.64
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$257.64 / $298.27 / $351.95
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$546.00 / $546.00 / $1,053.78
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$545.00 / $546.00 / $775.32
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15,611.46 / $16,734.58 / $23,534.51
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$473.78 / $473.78 / $473.78