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Ohio 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
$199.88 / $199.88 / $574.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$134.80 / $191.09 / $202.35
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$430.95 / $567.84 / $856.62
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$13,010.50 / $13,010.50 / $16,052.30
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$191.28 / $191.28 / $191.28
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.00 / $50.00 / $60.00