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Maryland 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
$106.69 / $145.16 / $157.11
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$187.20 / $271.00 / $287.26
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$182.61 / $236.21 / $307.56