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Pennsylvania 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
$311.06 / $348.77 / $348.77
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$252.98 / $332.41 / $422.84
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,000.00 / $8,639.91 / $79,506.39
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$409.19 / $424.63 / $424.63
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$348.77 / $348.77 / $348.77
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$252.98 / $332.41 / $422.84