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Nebraska 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
$128.82 / $128.82 / $128.82
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$128.82 / $154.88 / $213.80
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,041.74 / $2,691.53 / $5,248.07
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$234.42 / $245.47 / $245.47
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$128.82 / $218.78 / $331.13
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$154.88 / $1,047.13 / $1,047.13
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$229.09 / $257.04 / $398.11
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$263.03 / $354.81 / $371.54