go back

Massachusetts rates for HCPCS D4264

Bone Repl Gr - Ret Nat Tooth - Ea Add Site Quad

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$198.40 / $198.40 / $198.40
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$130.58 / $163.77 / $206.43
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$176.89 / $507.79 / $939.13
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$168.99 / $345.21 / $1,053.42
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$163.40 / $163.40 / $163.40
Fallon Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$83.43 / $4,618.00 / $9,239.00
Fallon Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$175.00 / $235.23 / $276.74
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$231.90 / $433.21 / $577.57
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$316.62 / $316.62 / $939.13
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,053.42 / $1,053.42 / $1,053.42