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Minnesota 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
$355.87 / $355.87 / $355.87
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$342.09 / $355.87 / $407.72
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,131.62 / $4,300.63 / $8,883.07
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,705.30 / $2,131.62 / $2,131.62
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$245.01 / $601.41 / $729.97
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,390.37 / $2,390.37 / $2,390.37