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Colorado 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
$154.96 / $154.96 / $154.96
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$106.69 / $154.96 / $163.36
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$170.79 / $170.79 / $170.79
Denver HMP
Facility/Professional
Facility
Modifier
Low / Median / High Price
$96.80 / $154.96 / $238.64
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$155.00 / $155.00 / $329.00