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Tennessee 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
$90.27 / $139.91 / $139.91
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$90.27 / $140.56 / $166.35
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$272.00 / $272.00 / $639.20
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$163.40 / $163.40 / $163.40
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$301.79 / $939.13 / $939.13
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,053.42 / $1,053.42 / $1,493.25