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Nebraska 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
$156.59 / $156.59 / $156.59
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$156.59 / $156.59 / $258.94
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,042.95 / $2,687.04 / $5,197.60
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$273.45 / $284.97 / $287.85
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$156.59 / $274.02 / $405.42
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$311.49 / $1,274.00 / $1,274.00
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$247.00 / $345.27 / $1,472.81
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$226.31 / $274.60 / $480.61