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Iowa rates for HCPCS D4264

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

Facilitymedian $162 · 10th–90th $155–$3090%20%40%10th90th$162Professionalmedian $162 · 10th–90th $107–$2140%20%10th90th$162$100.0$200.0$500.0$1.0K

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
$162.18 / $162.18 / $162.18
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$107.15 / $158.49 / $199.53
Hally Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$151.36 / $436.52 / $616.60
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$77.62 / $229.09 / $398.11
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$154.88 / $295.12 / $1,047.13
Midlands
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$169.82 / $257.04 / $398.11
Midlands
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$162.18 / $295.12 / $295.12
Wellmark
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$173.78 / $218.78 / $218.78