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Ohio 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
$347.47 / $347.47 / $1,470.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$329.33 / $347.47 / $475.16
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$545.00 / $632.20 / $1,005.03
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12,970.10 / $12,970.10 / $16,024.22
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.00 / $50.00 / $60.00