go back

Massachusetts 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
Facility
Modifier
Low / Median / High Price
$563.66 / $563.66 / $563.66
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$302.92 / $563.66 / $987.76
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$669.47 / $1,722.43 / $1,848.65
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$480.16 / $968.69 / $2,390.37
Fallon Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$83.43 / $4,618.00 / $9,239.00
Fallon Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$497.60 / $497.60 / $585.41
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$659.71 / $1,242.50 / $1,464.62
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$669.47 / $669.47 / $3,728.65
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,390.37 / $2,390.37 / $2,390.37