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Idaho rates for HCPCS D4264

Bone Replacement Graft - Retained Natural Tooth - Each Additional Site In Quadrant

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$136.22 / $160.51 / $195.90
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$66.98 / $160.51 / $227.97
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $2,000.00 / $3,900.00