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Montana rates for HCPCS D4263

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

Facilitymedian $363 · 10th–90th $275–$4070%50%10th90th$363Professionalmedian $186 · 10th–90th $158–$3630%50%10th90th$186$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
Professional
Modifier
Typical Low / Median / Typical High
$158.49 / $186.21 / $234.42
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$363.08 / $371.54 / $4,570.88
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$363.08 / $371.54 / $4,570.88
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$158.49 / $281.84 / $338.84
Providence
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$79.43 / $85.11 / $416.87