go back

Alabama rates for HCPCS D4263

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$231.88 / $231.88 / $231.88
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$120.98 / $179.46 / $231.88
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,417.53 / $1,720.24 / $2,314.28
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$241.00 / $241.00 / $241.00