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Montana 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 $646 · 10th–90th $537–$4,5710%50%10th90th$646Professionalmedian $389 · 10th–90th $324–$6310%20%10th90th$389$100.0$200.0$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
Professional
Modifier
Typical Low / Median / Typical High
$323.59 / $363.08 / $478.63
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$630.96 / $645.65 / $4,570.88
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$630.96 / $645.65 / $4,570.88
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$309.03 / $478.63 / $660.69
Providence
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$79.43 / $85.11 / $794.33