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Washington 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 $813 · 10th–90th $479–$4,6770%10%10th90th$813Professionalmedian $437 · 10th–90th $309–$8510%10%10th90th$437$50.0$200.0$1.0K$5.0K

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
$478.63 / $478.63 / $478.63
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$309.03 / $398.11 / $562.34
Kaiser Permanente
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$512.86 / $870.96 / $5,128.61
Kaiser Permanente
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$512.86 / $812.83 / $1,047.13
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$44.67 / $50.12 / $75.86
Pacific Source
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$426.58 / $707.95 / $707.95
Premera BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$707.95 / $707.95 / $707.95