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Indiana rates for HCPCS D4273

Autogenous Connective Tissue Graft Procedure (Including Donor And Recipient Surgical Sites) First Tooth, Implant, Or Edentulous Tooth Position In Graft

Facilitymedian $4,786 · 10th–90th $550–$6,3100%20%10th90th$4,786Professionalmedian $347 · 10th–90th $257–$6460%10%20%10th90th$347$500.0$1.0K$2.0K$5.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$257.04 / $257.04 / $3,311.31
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$257.04 / $331.13 / $436.52
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$549.54 / $4,786.30 / $6,309.57
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$549.54 / $602.56 / $870.96
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$302.00 / $331.13 / $371.54