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Alaska rates for HCPCS D4264

Bone Replacement Graft - Retained Natural Tooth - Each Additional Site In Quadrant

Facilitymedian $182 · 10th–90th $102–$2880%10%10th90th$182Professionalmedian $162 · 10th–90th $151–$2340%20%10th90th$162$100.0$200.0

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Small sample — interpret with caution. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$151.36 / $162.18 / $234.42
Moda Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$102.33 / $181.97 / $288.40
Moda Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$60.26 / $162.18 / $234.42
Premera BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$218.78 / $223.87 / $223.87
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$102.33 / $181.97 / $288.40
Providence
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$60.26 / $60.26 / $204.17