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Arizona rates for HCPCS D4264

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

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$140.56 / $146.19 / $163.22
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$84.24 / $160.81 / $296.77
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,053.42 / $1,053.42 / $1,053.42