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Wyoming rates for HCPCS D4264

Bone Replacement Graft - Retained Natural Tooth - Each Additional Site In Quadrant

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$154.96 / $162.18 / $195.90
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$331.00 / $331.00 / $331.00