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Texas 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
$160.10 / $160.10 / $177.43
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$151.93 / $177.43 / $197.31
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$80.00 / $80.00 / $80.00
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$367.69 / $5,062.89 / $5,062.89
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,274.00 / $1,274.00 / $1,820.10
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$155.63 / $198.09 / $339.41
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$201.25 / $201.25 / $201.25
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$178.80 / $178.80 / $178.80
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$155.63 / $198.09 / $339.52
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$237.98 / $2,250,000.00 / $2,400,000.00
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$209.00 / $209.00 / $282.14