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New York 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
$92.06 / $124.82 / $165.77
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$124.82 / $162.63 / $238.28
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$164.00 / $203.66 / $380.10
CDPHP
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,071.00 / $2,071.00 / $6,213.00
Excellus BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$172.65 / $300.00 / $300.00
MVP Health Care
Facility/Professional
Facility
Modifier
Low / Median / High Price
$555.00 / $597.00 / $74,999.25
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$191.30 / $191.30 / $191.30
Univera
Facility/Professional
Facility
Modifier
Low / Median / High Price
$203.12 / $203.12 / $203.12
Univera
Facility/Professional
Professional
Modifier
Low / Median / High Price
$203.12 / $203.12 / $300.00