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Louisiana rates for HCPCS D4264

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

Facilitymedian $155 · 10th–90th $155–$1820%50%90th$155Professionalmedian $155 · 10th–90th $129–$2040%20%10th90th$155$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. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$154.88 / $154.88 / $181.97
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$128.82 / $154.88 / $194.98
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$257.04 / $257.04 / $257.04