go back

Kentucky rates for HCPCS D4264

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

Facilitymedian $166 · 10th–90th $132–$1660%50%10th$166Professionalmedian $166 · 10th–90th $123–$3240%10%20%10th90th$166$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
$165.96 / $165.96 / $165.96
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$120.23 / $154.88 / $194.98
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$213.80 / $323.59 / $389.05
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$131.83 / $131.83 / $131.83
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$44.67 / $44.67 / $1,995.26