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Kentucky rates for HCPCS D4264

Bone Repl Gr - Ret Nat Tooth - Ea Add Site Quad

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$67.70 / $166.35 / $166.35
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$121.78 / $163.77 / $198.40
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$212.00 / $327.25 / $385.00
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.00 / $45.00 / $3,000.00