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Oklahoma rates for HCPCS D4264

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

Facilitymedian $135 · 10th–90th $132–$2000%50%10th90th$135Professionalmedian $151 · 10th–90th $129–$2000%50%10th90th$151$100.0$500.0$2.0K$10.0K$50.0K$200.0K

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
$134.90 / $134.90 / $134.90
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$128.82 / $151.36 / $199.53
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$107.15 / $144.54 / $275.42
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$67.61 / $177.83 / $1,047.13