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Connecticut 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
$347.62 / $347.62 / $347.62
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$106.69 / $141.69 / $347.62
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$100.30 / $159.50 / $320.17