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West Virginia rates for HCPCS D4264

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

Facilitymedian $112 · 10th–90th $112$1120%50%100%$112Professionalmedian $145 · 10th–90th $112$1660%20%10th90th$145$100.0

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
$112.20 / $112.20 / $112.20
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$112.20 / $144.54 / $165.96