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New York 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
$142.19 / $187.35 / $222.84
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$142.19 / $202.43 / $357.27
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$246.16 / $309.30 / $577.24
Excellus BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$225.63 / $508.53 / $508.53
MVP Health Care
Facility/Professional
Facility
Modifier
Low / Median / High Price
$555.00 / $597.00 / $74,999.25
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$155.00 / $165.00 / $325.00
Univera
Facility/Professional
Facility
Modifier
Low / Median / High Price
$265.45 / $265.45 / $265.45
Univera
Facility/Professional
Professional
Modifier
Low / Median / High Price
$265.45 / $508.53 / $508.53