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North Dakota 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
$154.76 / $154.76 / $154.76
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$140.97 / $154.76 / $168.20
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$287.91 / $319.08 / $342.95
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$89.04 / $154.76 / $292.20
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,053.42 / $1,053.42 / $1,053.42