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Nationwide rates for HCPCS D4264

Bone Replacement Graft - Retained Natural Tooth - Each Additional Site In Quadrant

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$128.82 / $154.88 / $199.53
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$123.03 / $151.36 / $194.98
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$389.05 / $389.05 / $741.31
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$141.25 / $213.80 / $512.86
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$95.50 / $131.83 / $50,118.72
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$123.03 / $141.25 / $269.15