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Montana 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
$194.25 / $194.25 / $196.05
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$135.19 / $236.95 / $304.87
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$196.36 / $294.58 / $1,800,000.00