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New York 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
$234.06 / $302.92 / $311.06
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$234.06 / $302.92 / $578.03
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$398.37 / $494.71 / $922.05
CDPHP
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,350.00 / $1,350.00 / $4,050.00
Excellus BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$303.00 / $303.00 / $353.09
MVP Health Care
Facility/Professional
Facility
Modifier
Low / Median / High Price
$555.00 / $597.00 / $74,999.25
Univera
Facility/Professional
Facility
Modifier
Low / Median / High Price
$353.09 / $353.09 / $353.09
Univera
Facility/Professional
Professional
Modifier
Low / Median / High Price
$353.09 / $353.09 / $1,166.24