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South Carolina rates for HCPCS D4263

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

Facilitymedian $417 · 10th–90th $178$3,1620%10%20%10th90th$417Professionalmedian $182 · 10th–90th $151$2340%20%10th90th$182$50.0$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
Facility
Modifier
Typical Low / Median / Typical High
$181.97 / $181.97 / $181.97
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$151.36 / $181.97 / $234.42
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$831.76 / $1,905.46 / $3,890.45
Medcost
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$158.49 / $204.17 / $354.81
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$30.20 / $30.20 / $54.95