Bone Replacement Graft — Each Additional Site (D4264) — National Rates

Negotiated reimbursement rates for D4264 across 45 states, sourced from CMS Transparency in Coverage data. 494 rate records.

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National Average Negotiated Rate
$174
494 rate records · 45 states
📊 Data updated monthly · Last refresh: March 2026

About D4264 — Bone Replacement Graft — Each Additional Site

D4264 refers to the procedure of Bone Replacement Graft for each additional site. This procedure is indicated when there is a need to augment bone in areas where it has been lost, often due to periodontal disease or trauma. Clinical documentation should include the specific sites treated, the rationale for the graft, and any imaging studies that support the need for the procedure. Billing for this code may vary by payor and state, with some insurance plans covering the procedure fully, while others may have limitations or require prior authorization. The average reimbursement for this procedure is around $174, but it is essential to check with individual payors for their specific policies and reimbursement rates.

Reimbursement rates for D4264 vary significantly by state, payor, and provider network. The national average negotiated rate is $174. Data sourced from CMS Transparency in Coverage machine-readable files, updated monthly.

Top Paying States for D4264

North Dakota
$334
6 records
Nevada
$326
14 records
Colorado
$326
20 records

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Full National Breakdown

Median
$155
Low
$48
High
$895

Highest & Lowest Reimbursement States

↑ Top 5

StateAvg Rate
North Dakota$334
Nevada$326
Colorado$326
Connecticut$273
South Carolina$256

↓ Bottom 5

StateAvg Rate
Louisiana$83
Oklahoma$82
Tennessee$72
Wyoming$64
Alabama$50

All States — D4264 Average Rates

North Dakota
$334
Nevada
$326
Colorado
$326
Connecticut
$273
South Carolina
$256
Rhode Island
$254
New York
$237
District of Columbia
$235
Washington
$220
Maine
$215
Utah
$209
Hawaii
$197
Michigan
$192
Georgia
$185
Ohio
$182
Oregon
$175
Florida
$174
Arizona
$173
California
$166
Iowa
$160
Nebraska
$159
Minnesota
$159
Texas
$157
Kentucky
$150
Wisconsin
$144
West Virginia
$138
New Hampshire
$134
New Jersey
$132
Massachusetts
$132
Pennsylvania
$130
Virginia
$127
Indiana
$126
Illinois
$120
Idaho
$119
Missouri
$114
New Mexico
$111
North Carolina
$96
Kansas
$95
Delaware
$95
Maryland
$92
Louisiana
$83
Oklahoma
$82
Tennessee
$72
Wyoming
$64
Alabama
$50
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State-by-State Comparison Table

StateAverageMedianMinMaxRecords
North Dakota$334$464$72$4646
Nevada$326$288$267$59514
Colorado$326$417$105$42120
Connecticut$273$275$263$27513
South Carolina$256$258$121$41614
Rhode Island$254$254$254$2541
New York$237$228$81$89527
District of Columbia$235$235$111$3592
Washington$220$211$108$4649
Maine$215$215$215$2151
Utah$209$262$102$2623
Hawaii$197$175$136$2755
Michigan$192$192$128$2562
Georgia$185$155$48$28423
Ohio$182$95$85$39410
Oregon$175$175$175$1757
Florida$174$186$74$41742
Arizona$173$176$80$24716
California$166$159$74$46439
Iowa$160$160$100$2202
Nebraska$159$159$159$1591
Minnesota$159$80$80$51216
Texas$157$165$105$25626
Kentucky$150$105$105$2568
Wisconsin$144$150$131$1503
West Virginia$138$138$138$1381
New Hampshire$134$143$73$1685
New Jersey$132$135$74$27522
Massachusetts$132$138$81$1704
Pennsylvania$130$94$81$37110
Virginia$127$124$75$1854
Indiana$126$105$78$41712
Illinois$120$120$48$1756
Idaho$119$117$79$1623
Missouri$114$108$100$15710
New Mexico$111$111$109$1132
North Carolina$96$85$74$42132
Kansas$95$100$77$1005
Delaware$95$95$95$951
Maryland$92$81$48$17632
Louisiana$83$83$71$952
Oklahoma$82$82$82$821
Tennessee$72$68$68$858
Wyoming$64$64$64$641
Alabama$50$48$48$587
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