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Pennsylvania rates for HCPCS D4264

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

Facilitymedian $151 · 10th–90th $151–$5,0120%50%90th$151Professionalmedian $145 · 10th–90th $107–$1950%50%10th90th$145$1.0$10.0$100.0$1.0K$10.0K

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
$151.36 / $151.36 / $151.36
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$123.03 / $144.54 / $199.53
Capital Blue Cross
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$5,011.87 / $8,511.38 / $77,624.71
Capital Blue Cross
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$75.86 / $79.43 / $79.43
Geisinger
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$67.61 / $67.61 / $151.36
Martin's Point
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$151.36 / $151.36 / $151.36
Martin's Point
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$123.03 / $151.36 / $194.98
Oscar Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$100.00 / $154.88 / $154.88