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Texas 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
$300.37 / $300.37 / $332.91
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$285.05 / $332.41 / $371.15
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$669.47 / $3,728.65 / $3,728.65
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,390.37 / $2,390.37 / $3,160.73
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$305.13 / $451.49 / $750.70
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$349.52 / $349.52 / $349.52
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$305.13 / $454.38 / $750.70
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$349.52 / $578.08 / $614.15
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$458.00 / $458.00 / $618.29