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Bone Graft For Gum Disease — First Site

Pennsylvania rates for HCPCS D4263

Placement of bone graft material into an area where gum disease has caused bone loss around a tooth, done to help rebuild lost bone and support for the tooth. This describes the graft placed at the first site treated within one section of the mouth during the same procedure, with any additional sites in that area handled as their own step. It's typically done alongside gum surgery rather than as a stand-alone visit.

Rates data updated July 2026.

How much does Bone Graft For Gum Disease — First Site cost?

$174

Typical negotiated rate. In Pennsylvania, July 2026.

Insurers have agreed to pay about $174 for this service. The price depends on where it is billed: about $174 from a physician practice, and about $186 from a hospital or other facility. The two figures are alternatives, not parts of one bill.

These are rates insurers have negotiated with providers, not the amount a patient is billed. What you owe depends on your plan's deductible and coinsurance. Based on rates published by 5 insurance carriers under federal price transparency rules.

Where it's billed changes the price

Billed byTypicalRange
Physician practiceA doctor's office, clinic or independent provider$174$158 to $195
FacilityA hospital or hospital-owned outpatient department$186$186 to $186

How much rates vary

Facilitymedian $186 · 10th to 90th $186 to $186Professionalmedian $174 · 10th to 90th $135 to $240
$100$500$2K$10K$50Kfacility $186professional $174

Distribution of negotiated rates across all payers (price axis is log-scale). Each curve is scaled to its own total: facility and professional rates are different services, shown together to compare where they cluster. Need provider-level prices or 24+ months of history? Contact us.

Rates by insurance carrier

Insurance Carrier
Aetna
Setting
Facility
Modifier
Global
Typical Low
$186.21
Median
$186.21
Typical High
$186.21
Aetna
Setting
Professional
Modifier
Global
Typical Low
$151.36
Median
$173.78
Typical High
$239.88
Capital Blue Cross
Setting
Facility
Modifier
Global
Typical Low
$5,011.87
Median
$8,511.38
Typical High
$77,624.71
Capital Blue Cross
Setting
Professional
Modifier
Global
Typical Low
$147.91
Median
$154.88
Typical High
$154.88
Geisinger
Setting
Professional
Modifier
Global
Typical Low
$134.90
Median
$134.90
Typical High
$562.34
Martin's Point
Setting
Facility
Modifier
Global
Typical Low
$186.21
Median
$186.21
Typical High
$186.21
Martin's Point
Setting
Professional
Modifier
Global
Typical Low
$154.88
Median
$186.21
Typical High
$239.88
Oscar Health
Setting
Professional
Modifier
Global
Typical Low
$177.83
Median
$177.83
Typical High
$177.83

Where Pennsylvania sits

The same service costs 6.3 times more in Minnesota than in Vermont. Every bar is a state, most expensive first. Touch or drag across it to read any state, then open that state for its carriers and full range.

Pennsylvania· 43rd of 51

$174

MN $794VT $126

Median negotiated rate in each state, from every insurer that publishes one. States where no insurer publishes a rate for this service are not shown.