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Alaska rates for HCPCS D4263

Bone Replacement Graft - Retained Natural Tooth - First Site In Quadrant

Facilitymedian $234 · 10th–90th $166–$3550%10%20%10th90th$234Professionalmedian $195 · 10th–90th $178–$2820%50%10th90th$195$100.0$200.0$500.0

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
Professional
Modifier
Typical Low / Median / Typical High
$177.83 / $194.98 / $281.84
Moda Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$165.96 / $234.42 / $354.81
Moda Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$60.26 / $194.98 / $281.84
Premera BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$416.87 / $478.63 / $489.78
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$165.96 / $234.42 / $354.81
Providence
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$60.26 / $60.26 / $239.88