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Washington, DC rates for HCPCS D4264

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

Facilitymedian $158 · 10th–90th $158–$1580%50%100%$158Professionalmedian $148 · 10th–90th $120–$2000%20%10th90th$148$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
Facility
Modifier
Typical Low / Median / Typical High
$158.49 / $158.49 / $158.49
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$120.23 / $147.91 / $199.53
CareFirst
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$269.15 / $295.12 / $323.59
Kaiser Permanente
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$186.21 / $194.98 / $398.11