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South Dakota rates for HCPCS D4263

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$204.64 / $204.64 / $204.64
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$196.71 / $204.64 / $204.64
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$206.80 / $274.12 / $400.66
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$194.87 / $1,274.00 / $1,274.00
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$251.40 / $372.72 / $2,097.63
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$226.00 / $269.25 / $520.92
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$458.00 / $458.00 / $458.00