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GRAFTJACKET XPRESS Injectable

Montana rates for HCPCS Q4113

GRAFTJACKET XPRESS, injectable, 1 cc

Rates data updated July 2026.

Facilitymedian $575 · 10th–90th $437$9770%20%10th90th$575Professionalmedian $741 · 10th–90th $724$1,9950%50%10th90th$741$100.0$200.0$500.0$1.0K$2.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Setting
Professional
Modifier
Global
Typical Low
$724.44
Median
$741.31
Typical High
$758.58
Cigna
Setting
Facility
Modifier
Global
Typical Low
$870.96
Median
$870.96
Typical High
$870.96
Cigna
Setting
Professional
Modifier
Global
Typical Low
$758.58
Median
$758.58
Typical High
$1,000.00
MountainHealth Co-op
Setting
Facility
Modifier
Global
Typical Low
$467.74
Median
$467.74
Typical High
$549.54
MountainHealth Co-op
Setting
Professional
Modifier
Global
Typical Low
$467.74
Median
$467.74
Typical High
$549.54
Providence
Setting
Facility
Modifier
Global
Typical Low
$398.11
Median
$758.58
Typical High
$1,288.25
Providence
Setting
Professional
Modifier
Global
Typical Low
$79.43
Median
$309.03
Typical High
$1,380.38
United
Setting
Professional
Modifier
Global
Typical Low
$1,995.26
Median
$1,995.26
Typical High
$1,995.26