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GRAFTJACKET

Nationwide rates for HCPCS Q4107

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

Rates data updated July 2026.

Facilitymedian $112 · 10th–90th $85$3310%20%40%10th90th$112Professionalmedian $85 · 10th–90th $81$1260%50%10th90th$85$0.1$2.0$50.0$1.0K$20.0K$500.0K

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
Facility
Modifier
Global
Typical Low
$81.28
Median
$85.11
Typical High
$199.53
Aetna
Setting
Professional
Modifier
Global
Typical Low
$81.28
Median
$83.18
Typical High
$89.13
BCBS
Setting
Facility
Modifier
Global
Typical Low
$85.11
Median
$109.65
Typical High
$275.42
BCBS
Setting
Professional
Modifier
Global
Typical Low
$81.28
Median
$95.50
Typical High
$141.25
Cigna
Setting
Facility
Modifier
Global
Typical Low
$128.82
Median
$194.98
Typical High
$346.74
Cigna
Setting
Professional
Modifier
Global
Typical Low
$107.15
Median
$125.89
Typical High
$125.89
United
Setting
Facility
Modifier
Global
Typical Low
$102.33
Median
$125.89
Typical High
$245.47
United
Setting
Professional
Modifier
Global
Typical Low
$100.00
Median
$125.89
Typical High
$134.90