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Virginia rates for HCPCS D4263

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

Facilitymedian $195 · 10th–90th $145–$3980%20%10th90th$195Professionalmedian $195 · 10th–90th $158–$3550%20%10th90th$195$100.0$200.0$500.0$1.0K$2.0K$5.0K$10.0K

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$190.55 / $190.55 / $194.98
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$151.36 / $181.97 / $204.17
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$213.80 / $239.88 / $446.68
CareFirst
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$371.54 / $436.52 / $588.84
Kaiser Permanente
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$208.93 / $263.03 / $309.03
Medcost
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$141.25 / $204.17 / $331.13
Medcost
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$147.91 / $147.91 / $147.91
Sentara
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$141.25 / $204.17 / $10,000.00
Sentara
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$141.25 / $204.17 / $10,000.00