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Missouri rates for HCPCS D4263

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

Facilitymedian $245 · 10th–90th $186–$4900%20%10th90th$245Professionalmedian $195 · 10th–90th $148–$2510%10%20%10th90th$195$100.0$200.0$500.0$1.0K$2.0K$5.0K

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
$208.93 / $245.47 / $245.47
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$151.36 / $181.97 / $245.47
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$131.83 / $213.80 / $302.00
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$257.04 / $346.74 / $537.03
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$162.18 / $245.47 / $549.54
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,288.25 / $1,288.25 / $1,288.25