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Florida 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
$103.07 / $132.74 / $145.96
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$103.07 / $145.96 / $165.16
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$163.40 / $163.40 / $163.40
Florida Blue
Facility/Professional
Professional
Modifier
Low / Median / High Price
$121.66 / $165.11 / $282.14
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.00 / $40.00 / $50.00
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$118.00 / $118.00 / $118.00