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GRAFTJACKET

Alaska rates for HCPCS Q4107

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

Rates data updated October 2026.

How much does GRAFTJACKET cost?

$138

Typical negotiated rate. In Alaska, October 2026.

Insurers have agreed to pay about $138 for this service. The price depends on where it is billed: about $138 from a physician practice, and about $257 from a hospital or other facility.

These are rates insurers have negotiated with providers, not the amount a patient is billed. What you owe depends on your plan's deductible and coinsurance. Based on rates published by 6 insurance carriers under federal price transparency rules.

Prices by location type

Billed byTypicalRange
Physician practiceA doctor's office, clinic or independent provider$138$138 to $191
FacilityA hospital or hospital-owned outpatient department$257$162 to $316

How much rates vary

Facilitymedian $257 · 10th to 90th $138 to $550Professionalmedian $138 · 10th to 90th $100 to $339
$100$200$500$1Kfacility $257professional $138

Distribution of negotiated rates across all payers (price axis is log-scale). Small sample; interpret with caution. Need provider-level prices or 24+ months of history? Contact us.

Rates by insurance carrier

Insurance Carrier
Aetna
Setting
Facility
Modifier
None
Typical Low
$138.04
Median
$138.04
Typical High
$138.04
Aetna
Setting
Professional
Modifier
None
Typical Low
$83.18
Median
$138.04
Typical High
$138.04
Cigna
Setting
Facility
Modifier
None
Typical Low
$186.21
Median
$316.23
Typical High
$933.25
Cigna
Setting
Professional
Modifier
None
Typical Low
$125.89
Median
$125.89
Typical High
$125.89
Moda Health
Setting
Facility
Modifier
None
Typical Low
$93.33
Median
$138.04
Typical High
$194.98
Moda Health
Setting
Professional
Modifier
None
Typical Low
$138.04
Median
$138.04
Typical High
$416.87
Premera BCBS
Setting
Facility
Modifier
None
Typical Low
$141.25
Median
$204.17
Typical High
$467.74
Premera BCBS
Setting
Professional
Modifier
None
Typical Low
$95.50
Median
$100.00
Typical High
$120.23
Providence
Setting
Facility
Modifier
None
Typical Low
$128.82
Median
$302.00
Typical High
$933.25
Providence
Setting
Professional
Modifier
None
Typical Low
$60.26
Median
$125.89
Typical High
$125.89
United
Setting
Professional
Modifier
None
Typical Low
$125.89
Median
$190.55
Typical High
$380.19

Where Alaska sits

The same service costs 1.8 times more in North Dakota than in Virginia. Every bar is a state, most expensive first. Touch or drag across it to read any state, then open that state for its carriers and full range.

Alaska· 2nd of 51

$138

ND $151VA $85.11

Median negotiated rate in each state, from every insurer that publishes one. States where no insurer publishes a rate for this service are not shown.