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Missouri 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
$198.70 / $244.41 / $244.41
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$177.43 / $198.70 / $244.41
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$130.88 / $213.84 / $300.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$191.28 / $191.28 / $191.28
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$165.46 / $244.41 / $508.37
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,274.00 / $1,274.00 / $1,274.00