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Virginia rates for HCPCS D4273

Autogenous Connective Tissue Graft Procedure

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$332.41 / $475.16 / $475.16
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$329.33 / $371.15 / $475.16
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$816.00 / $816.00 / $1,082.33
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$478.80 / $536.26 / $933.66
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$349.65 / $419.58 / $517.48
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$329.90 / $475.16 / $723.67
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$507.00 / $864.00 / $897.60
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$302.38 / $441.93 / $9,929.00
Sentara
Facility/Professional
Professional
Modifier
Low / Median / High Price
$314.86 / $441.93 / $9,929.00