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Wisconsin 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 $282 · 10th–90th $282–$2,5120%50%90th$282Professionalmedian $398 · 10th–90th $282–$1,1480%10%10th90th$398$100.0$200.0$500.0$1.0K$2.0K$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. Small sample — interpret with caution. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$281.84 / $281.84 / $281.84
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$281.84 / $331.13 / $562.34
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$398.11 / $707.95 / $1,318.26
DeanCare
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$281.84 / $398.11 / $707.95
DeanCare
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$316.23 / $316.23 / $316.23
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$281.84 / $426.58 / $724.44
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$316.23 / $2,398.83 / $2,398.83
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$50.12 / $54.95 / $70.79
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$489.78 / $870.96 / $1,318.26
Quartz
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2,511.89 / $2,511.89 / $3,715.35
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,949.84 / $2,398.83 / $2,398.83
Security Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$457.09 / $478.63 / $524.81