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Georgia 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
$141.25 / $141.25 / $141.25
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$128.82 / $151.36 / $194.98
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$70.79 / $162.18 / $269.15
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$186.21 / $186.21 / $758.58