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New Jersey 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
$72.65 / $72.65 / $72.65
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$72.65 / $148.69 / $163.22
Horizon BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$140.28 / $165.04 / $169.96