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Florida rates for HCPCS D4264

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

Facilitymedian $132 · 10th–90th $102–$1320%50%10th$132Professionalmedian $145 · 10th–90th $107–$1950%20%10th90th$145$50.0$100.0$200.0$500.0

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$102.33 / $131.83 / $131.83
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$112.20 / $144.54 / $190.55
Florida Blue
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $151.36 / $275.42
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$39.81 / $39.81 / $50.12
Wellpoint
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$117.49 / $117.49 / $117.49