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Maine 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
$134.46 / $198.40 / $246.10
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$144.69 / $277.94 / $326.82
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$231.90 / $268.31 / $411.60
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$163.22 / $203.07 / $246.10