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Nebraska 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
$272.30 / $272.30 / $272.30
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$272.30 / $272.30 / $272.30
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,167.96 / $2,938.14 / $5,515.65
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$663.54 / $698.47 / $698.47
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$272.30 / $462.91 / $939.15
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$650.70 / $2,390.37 / $2,390.37
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$440.59 / $722.67 / $1,300.32
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$490.15 / $653.85 / $999.93