go back

Oklahoma 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
$136.83 / $136.83 / $136.83
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$136.83 / $138.44 / $166.35
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$114.25 / $138.44 / $227.08
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$68.09 / $179.75 / $1,053.42