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Massachusetts rates for HCPCS D4264

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

Facilitymedian $200 · 10th–90th $200–$1,0470%50%90th$200Professionalmedian $195 · 10th–90th $132–$4570%10%10th90th$195$100.0$500.0$2.0K$10.0K$50.0K

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
$199.53 / $199.53 / $199.53
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$123.03 / $158.49 / $199.53
AllWays Health Partners
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$177.83 / $512.86 / $1,047.13
AllWays Health Partners
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$169.82 / $281.84 / $1,047.13
Fallon Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$60.26 / $3,630.78 / $8,511.38
Fallon Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$234.42 / $234.42 / $275.42
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$194.98 / $354.81 / $512.86
Mass General Brigham
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$177.83 / $512.86 / $1,047.13
Mass General Brigham
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$169.82 / $281.84 / $1,047.13