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Mississippi 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
$98.35 / $98.35 / $171.72
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$98.35 / $152.94 / $191.77
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$74.00 / $74.00 / $74.00
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17.00 / $21.25 / $50.00