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Montana rates for HCPCS Q4209

SurGraft, per sq cm (add-on, list separately in addition to primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$350.00 / $350.00 / $350.00
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,800,000.00 / $2,250,000.00 / $2,400,000.00