go back

Montana rates for HCPCS Q4113

Graftjacket Xpress

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$718.00 / $744.93 / $744.93
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$762.88 / $762.88 / $762.88
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$762.88 / $762.88 / $997.63
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$354.72 / $897.50 / $1,375.00
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$762.88 / $1,320.00 / $1,925.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,997.50 / $1,997.50 / $1,997.50