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South 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
$152.05 / $152.05 / $152.05
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$130.58 / $152.05 / $165.16
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,057.16 / $2,216.51 / $3,868.86
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$72.89 / $152.05 / $258.49
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,000.00 / $3,000.00 / $3,000.00