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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

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$367.93 / $367.93 / $367.93
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$738.76 / $738.76 / $738.76
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$368.47 / $552.76 / $797.30