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Wisconsin rates for HCPCS D4263

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

Facilitymedian $191 · 10th–90th $162–$4070%20%10th90th$191Professionalmedian $204 · 10th–90th $162–$5890%10%20%10th90th$204$50.0$100.0$200.0$500.0$1.0K$2.0K$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
$162.18 / $162.18 / $162.18
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$162.18 / $186.21 / $234.42
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$165.96 / $316.23 / $691.83
DeanCare
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$162.18 / $194.98 / $323.59
DeanCare
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$109.65 / $109.65 / $109.65
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$162.18 / $204.17 / $323.59
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,288.25 / $1,288.25 / $1,288.25
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$50.12 / $58.88 / $70.79
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$281.84 / $501.19 / $707.95
Quartz
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$3,467.37 / $3,467.37 / $5,011.87
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$891.25 / $1,288.25 / $1,288.25
Security Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$389.05 / $407.38 / $457.09