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Texas rates for HCPCS D4264

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

Facilitymedian $155 · 10th–90th $85–$3090%10%10th90th$155Professionalmedian $148 · 10th–90th $129–$1950%20%10th90th$148$50.0$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. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$131.83 / $134.90 / $144.54
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$128.82 / $147.91 / $181.97
Christus
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$79.43 / $79.43 / $79.43
Lucent Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,047.13 / $1,047.13 / $1,047.13
Lucent Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,047.13 / $1,479.11 / $1,479.11
Moda Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$85.11 / $162.18 / $281.84
Moda Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$128.82 / $144.54 / $165.96
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$30.20 / $30.20 / $30.20
Oscar Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$154.88 / $154.88 / $154.88
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$85.11 / $162.18 / $281.84
Providence
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$60.26 / $169.82 / $269.15
Wellpoint
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$117.49 / $117.49 / $117.49