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Maine 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
$162.63 / $232.29 / $292.47
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$209.00 / $325.55 / $382.56
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$271.88 / $314.57 / $482.56
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$189.66 / $232.29 / $292.47