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Minnesota 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
$168.20 / $168.20 / $168.20
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$136.22 / $168.20 / $198.40
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.98 / $724.46 / $1,400.49
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$600.35 / $707.58 / $729.46
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$104.38 / $187.34 / $316.62
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$255.71 / $1,053.42 / $1,053.42