go back

South Carolina rates for HCPCS D4263

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$184.96 / $184.96 / $184.96
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$152.82 / $184.96 / $199.72
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,057.16 / $2,216.51 / $3,868.86
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$135.86 / $184.96 / $314.43
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,000.00 / $3,000.00 / $3,000.00