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Massachusetts rates for HCPCS D4263

Bone Repl Graft - Ret Nat Tooth - 1st Site Quad

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$232.29 / $232.29 / $232.29
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$152.82 / $199.88 / $242.24
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$207.06 / $647.75 / $941.10
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$197.84 / $404.15 / $1,274.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$191.28 / $191.28 / $191.28
Fallon Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$83.43 / $4,618.00 / $9,239.00
Fallon Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$236.00 / $286.50 / $337.06
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$271.88 / $507.90 / $677.14
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$385.42 / $385.42 / $5,062.89
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,274.00 / $1,274.00 / $1,274.00