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Washington rates for HCPCS D4273

Autogenous Connective Tissue Graft Procedure

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$479.01 / $479.01 / $479.01
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$309.26 / $435.37 / $479.01
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,254.48 / $3,728.65 / $3,728.65
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$821.00 / $2,390.37 / $3,257.55
Kaiser Permanente
Facility/Professional
Facility
Modifier
Low / Median / High Price
$513.94 / $878.65 / $2,059.66
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$513.94 / $867.44 / $1,074.92
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.00 / $50.00 / $50.00
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$489.53 / $715.88 / $2,303.00
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$679.00 / $703.17 / $703.17