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Montana 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
Professional
Modifier
Low / Median / High Price
$239.88 / $263.03 / $309.03
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Low / Median / High Price
$457.09 / $478.63 / $501.19
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Low / Median / High Price
$457.09 / $478.63 / $501.19
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$257.04 / $354.81 / $446.68
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.43 / $85.11 / $575.44