go back

Missouri 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
$345.63 / $425.13 / $425.13
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$298.27 / $345.63 / $425.13
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$153.63 / $485.00 / $646.83
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$464.64 / $464.64 / $464.64
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$345.63 / $446.39 / $971.22
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,390.37 / $2,390.37 / $2,390.37