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Alabama 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
$191.77 / $191.77 / $191.77
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$103.07 / $152.94 / $191.77
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,417.53 / $1,720.24 / $2,314.28
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$137.00 / $137.00 / $137.00