go back

New Mexico rates for HCPCS D4263

Bone Repl Graft - Ret Nat Tooth - 1st Site Quad

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$161.79 / $161.79 / $161.79
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$161.79 / $178.06 / $179.52
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.00 / $70.00 / $1,500.00
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$151.21 / $159.87 / $208.85
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,400,000.00 / $2,400,000.00 / $2,400,000.00