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Virginia rates for HCPCS D4263

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$191.09 / $195.62 / $195.62
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$124.82 / $191.09 / $195.62
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$213.00 / $213.00 / $355.58
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$410.00 / $410.00 / $774.90
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$191.28 / $191.28 / $191.28
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$201.31 / $257.68 / $304.45
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$139.60 / $195.62 / $305.74
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$272.00 / $352.21 / $497.04
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$143.44 / $203.86 / $9,929.00
Sentara
Facility/Professional
Professional
Modifier
Low / Median / High Price
$143.44 / $203.86 / $9,929.00