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Bone Graft Around a Tooth, Each Additional Site

Minnesota rates for HCPCS D4264

Placing bone graft material around the root of a tooth you still have, to help rebuild bone that has been lost to gum disease, for each additional site treated beyond the first. It is typically done together with gum surgery, with the goal of supporting the tooth and encouraging new bone to form.

Rates data updated July 2026.

How much does Bone Graft Around a Tooth, Each Additional Site cost?

$724

Typical negotiated rate. In Minnesota, July 2026.

Insurers have agreed to pay about $724 for this service. The price depends on where it is billed: about $724 from a physician practice, and about $759 from a hospital or other facility. The two figures are alternatives, not parts of one bill.

These are rates insurers have negotiated with providers, not the amount a patient is billed. What you owe depends on your plan's deductible and coinsurance. Based on rates published by 3 insurance carriers under federal price transparency rules.

Where it's billed changes the price

Billed byTypicalRange
Physician practiceA doctor's office, clinic or independent provider$724$589 to $724
FacilityA hospital or hospital-owned outpatient department$759$170 to $912

How much rates vary

Facilitymedian $759 · 10th to 90th $170 to $1,738Professionalmedian $724 · 10th to 90th $162 to $724
$100$200$500$1K$2K$5Kfacility $759professional $724

Distribution of negotiated rates across all payers (price axis is log-scale). Each curve is scaled to its own total: facility and professional rates are different services, shown together to compare where they cluster. Need provider-level prices or 24+ months of history? Contact us.

Rates by insurance carrier

Insurance Carrier
Aetna
Setting
Facility
Modifier
Global
Typical Low
$169.82
Median
$169.82
Typical High
$169.82
Aetna
Setting
Professional
Modifier
Global
Typical Low
$134.90
Median
$154.88
Typical High
$194.98
BCBS
Setting
Facility
Modifier
Global
Typical Low
$758.58
Median
$870.96
Typical High
$3,019.95
BCBS
Setting
Professional
Modifier
Global
Typical Low
$588.84
Median
$724.44
Typical High
$724.44
Medica
Setting
Facility
Modifier
Global
Typical Low
$102.33
Median
$186.21
Typical High
$295.12
Medica
Setting
Professional
Modifier
Global
Typical Low
$257.04
Median
$1,047.13
Typical High
$1,047.13

Where Minnesota sits

The same service costs 6.8 times more in Minnesota than in Vermont. Every bar is a state, most expensive first. Touch or drag across it to read any state, then open that state for its carriers and full range.

Minnesota· 1st of 51

$724

MN $724VT $107

Median negotiated rate in each state, from every insurer that publishes one. States where no insurer publishes a rate for this service are not shown.