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Oregon rates for HCPCS D4264

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

Facilitymedian $324 · 10th–90th $162$3390%50%10th90th$324Professionalmedian $151 · 10th–90th $132$1950%20%10th90th$151$100.0$200.0$500.0

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
$162.18 / $162.18 / $162.18
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$131.83 / $151.36 / $190.55
Kaiser Permanente
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$288.40 / $380.19 / $436.52
Moda Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$128.82 / $173.78 / $323.59
Moda Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$131.83 / $151.36 / $194.98
Pacific Source
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$229.09 / $338.84 / $338.84
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$128.82 / $177.83 / $323.59
Providence
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$70.79 / $79.43 / $512.86