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Utah 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
$136.22 / $136.22 / $136.22
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$136.22 / $146.72 / $160.51
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $45.00 / $162.18