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North Carolina 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
$165.16 / $165.16 / $165.16
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$137.09 / $165.16 / $191.77
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$96.04 / $130.47 / $326.89
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$70.73 / $132.94 / $228.26
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$132.94 / $132.94 / $223.00
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$226.80 / $226.80 / $226.80
Wellcare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$301.79 / $939.13 / $939.13
Wellcare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,053.42 / $1,493.25 / $1,493.25