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California rates for HCPCS D4261

Osseous Surgery (Including Elevation Of A Full Thickness Flap And Closure) - One To Three Contiguous Teeth Or Tooth Bounded Spaces Per Quadrant

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$269.15 / $269.15 / $288.40
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$204.17 / $251.19 / $323.59
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$245.47 / $323.59 / $389.05
Blue Shield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$323.59 / $446.68 / $851.14
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$141.25 / $141.25 / $398.11
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,698.24 / $1,698.24 / $1,698.24
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,698.24 / $2,398.83 / $2,398.83
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$245.47 / $354.81 / $489.78
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.43 / $288.40 / $436.52