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New Hampshire 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
$107.15 / $147.91 / $204.17
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$117.49 / $194.98 / $281.84
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$234.42 / $354.81 / $512.86