go back

New York 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 / $106.69 / $137.09
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$106.69 / $134.46 / $203.07
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$136.66 / $165.28 / $317.95
CDPHP
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,350.00 / $1,350.00 / $4,050.00
Excellus BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$166.44 / $166.44 / $166.44
MVP Health Care
Facility/Professional
Facility
Modifier
Low / Median / High Price
$555.00 / $597.00 / $74,999.25
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$162.62 / $162.62 / $162.62
Univera
Facility/Professional
Facility
Modifier
Low / Median / High Price
$166.44 / $166.44 / $166.44
Univera
Facility/Professional
Professional
Modifier
Low / Median / High Price
$166.44 / $166.44 / $166.44