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New Hampshire 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
$563.66 / $578.03 / $578.03
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$458.00 / $578.16 / $789.71
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$659.71 / $1,308.73 / $2,173.15