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Indiana rates for HCPCS D4263

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

Facilitymedian $1,995 · 10th–90th $513–$2,6300%20%10th90th$1,995Professionalmedian $191 · 10th–90th $148–$5130%10%20%10th90th$191$100.0$200.0$500.0$1.0K$2.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$147.91 / $147.91 / $630.96
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$147.91 / $181.97 / $234.42
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$512.86 / $1,995.26 / $2,630.27
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$426.58 / $512.86 / $812.83
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$117.49 / $154.88 / $173.78