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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
$263.58 / $263.58 / $263.58
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$456.67 / $456.67 / $456.67
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$263.98 / $396.00 / $571.20