go back

Indiana 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
$121.78 / $121.78 / $121.78
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$121.78 / $144.43 / $166.35
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$386.00 / $386.00 / $744.98
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$308.80 / $386.00 / $532.67
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$166.68 / $166.68 / $166.68