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Louisiana 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
$136.65 / $154.13 / $184.22
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$136.65 / $154.13 / $184.22
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$223.33 / $257.00 / $262.14