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Arkansas rates for HCPCS D4264

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$144.54 / $144.54 / $144.54
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$128.82 / $144.54 / $169.82