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South Dakota rates for HCPCS D4264

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

Facilitymedian $170 · 10th–90th $155–$2750%20%40%10th90th$170Professionalmedian $162 · 10th–90th $145–$1950%20%40%10th90th$162$100.0$200.0$500.0$1.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Small sample — interpret with caution. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$154.88 / $169.82 / $169.82
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$144.54 / $162.18 / $194.98
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$102.33 / $234.42 / $281.84
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$158.49 / $1,047.13 / $1,047.13
Midlands
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$181.97 / $229.09 / $257.04
Midlands
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$181.97 / $181.97 / $323.59
Wellmark
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$218.78 / $218.78 / $218.78