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Idaho rates for HCPCS D4263

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

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$159.87 / $194.16 / $234.97
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$132.34 / $194.16 / $267.19
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,375.47 / $1,375.47 / $1,500.21
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $2,000.00 / $3,900.00