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Nevada 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
$151.37 / $151.37 / $162.18
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$146.19 / $151.37 / $198.40
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$153.60 / $173.72 / $386.00
Hometown Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$200.00 / $293.00 / $493.00