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Washington rates for HCPCS D4263

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

Facilitymedian $316 · 10th–90th $178–$1,4130%10%10th90th$316Professionalmedian $195 · 10th–90th $158–$4070%20%10th90th$195$50.0$200.0$1.0K$5.0K

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
$234.42 / $234.42 / $234.42
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$158.49 / $190.55 / $234.42
Kaiser Permanente
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$169.82 / $288.40 / $1,949.84
Kaiser Permanente
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$169.82 / $263.03 / $512.86
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$44.67 / $50.12 / $64.57
Pacific Source
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$245.47 / $416.87 / $416.87
Premera BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$398.11 / $398.11 / $398.11