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Minnesota rates for HCPCS D4264

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

Facilitymedian $724 · 10th–90th $170–$1,7380%10%20%10th90th$724Professionalmedian $724 · 10th–90th $141–$7240%50%10th$724$100.0$200.0$500.0$1.0K$2.0K$5.0K

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
$169.82 / $169.82 / $169.82
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$120.23 / $151.36 / $194.98
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$724.44 / $870.96 / $1,949.84
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$588.84 / $724.44 / $724.44
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$102.33 / $186.21 / $295.12
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$257.04 / $1,047.13 / $1,047.13