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Bone Graft Around a Tooth, Each Additional Site

West Virginia rates for HCPCS D4264

Placing bone graft material around the root of a tooth you still have, to help rebuild bone that has been lost to gum disease, for each additional site treated beyond the first. It is typically done together with gum surgery, with the goal of supporting the tooth and encouraging new bone to form.

Rates data updated July 2026.

How much rates vary

Facilitymedian $112 · 10th to 90th $112 to $112Professionalmedian $158 · 10th to 90th $112 to $166
facility $112professional $158

Distribution of negotiated rates across all payers (price axis is log-scale). Each curve is scaled to its own total: facility and professional rates are different services, shown together to compare where they cluster. Small sample; interpret with caution. Need provider-level prices or 24+ months of history? Contact us.

Rates by insurance carrier

Insurance Carrier
Aetna
Setting
Facility
Modifier
Global
Typical Low
$112.20
Median
$112.20
Typical High
$112.20
Aetna
Setting
Professional
Modifier
Global
Typical Low
$112.20
Median
$158.49
Typical High
$165.96