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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

Facilitymedian $427 · 10th–90th $302–$8510%10%10th90th$427Professionalmedian $355 · 10th–90th $295–$4790%20%10th90th$355$50.0$100.0$200.0$500.0$1.0K$2.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$302.00 / $302.00 / $331.13
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$295.12 / $354.81 / $478.63
Lucent Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$3,715.35 / $3,715.35 / $3,715.35
Lucent Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2,398.83 / $3,162.28 / $3,162.28
Moda Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$309.03 / $436.52 / $724.44
Moda Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$281.84 / $346.74 / $478.63
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$30.20 / $30.20 / $30.20
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$309.03 / $436.52 / $741.31
Providence
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$60.26 / $363.08 / $616.60
Wellpoint
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$457.09 / $457.09 / $758.58