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South Dakota rates for HCPCS D4263

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

Facilitymedian $209 · 10th–90th $204–$3390%20%40%10th90th$209Professionalmedian $200 · 10th–90th $178–$2340%20%40%10th90th$200$200.0$500.0$1.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Small sample — interpret with caution. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$181.97 / $204.17 / $204.17
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$177.83 / $199.53 / $234.42
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$208.93 / $275.42 / $398.11
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$194.98 / $1,288.25 / $1,288.25
Midlands
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$269.15 / $269.15 / $309.03
Midlands
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$281.84 / $281.84 / $380.19
Wellmark
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$457.09 / $457.09 / $457.09