go back

Michigan 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
$190.55 / $190.55 / $190.55
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$147.91 / $181.97 / $234.42
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$190.55 / $190.55 / $190.55
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$151.36 / $190.55 / $234.42