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West Virginia 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
$111.51 / $111.51 / $111.51
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$111.51 / $157.11 / $347.62