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Illinois rates for HCPCS D4264

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

Facilitymedian $141 · 10th–90th $141–$1410%50%$141Professionalmedian $155 · 10th–90th $123–$2040%20%10th90th$155$50.0$100.0$200.0$500.0$1.0K$2.0K

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
$141.25 / $141.25 / $141.25
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$123.03 / $151.36 / $199.53
Hally Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$275.42 / $478.63 / $630.96
Hally Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$100.00 / $100.00 / $100.00
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$30.20 / $30.20 / $1,513.56