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Washington, DC 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
$157.11 / $157.11 / $157.11
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$157.11 / $157.11 / $157.11
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$208.00 / $271.00 / $295.39
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$182.61 / $394.73 / $394.73