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Maine 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
$578.03 / $648.20 / $648.20
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$555.92 / $789.71 / $928.54
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$659.71 / $763.28 / $1,170.92
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$578.03 / $648.20 / $648.20