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Utah rates for HCPCS D4263

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

Facilitymedian $158 · 10th–90th $158–$1580%50%100%$158Professionalmedian $182 · 10th–90th $158–$2510%20%40%10th90th$182$50.0$100.0$200.0

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
$158.49 / $158.49 / $158.49
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$158.49 / $181.97 / $204.17
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$30.20 / $44.67 / $257.04
Select Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$223.87 / $234.42 / $234.42
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$251.19 / $281.84 / $323.59