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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 July 2026.

Facilitymedian $138 · 10th–90th $87$2570%10%10th90th$138Professionalmedian $138 · 10th–90th $81$4070%20%10th90th$138$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
$81.28
Median
$83.18
Typical High
$138.04
Cigna
Setting
Facility
Modifier
Global
Typical Low
$144.54
Median
$144.54
Typical High
$144.54
Cigna
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$125.89
Moda Health
Setting
Facility
Modifier
Global
Typical Low
$85.11
Median
$112.20
Typical High
$177.83
Moda Health
Setting
Professional
Modifier
Global
Typical Low
$194.98
Median
$309.03
Typical High
$512.86
Premera BCBS
Setting
Facility
Modifier
Global
Typical Low
$141.25
Median
$162.18
Typical High
$467.74
Premera BCBS
Setting
Professional
Modifier
Global
Typical Low
$95.50
Median
$112.20
Typical High
$120.23
Providence
Setting
Facility
Modifier
Global
Typical Low
$87.10
Median
$120.23
Typical High
$302.00
Providence
Setting
Professional
Modifier
Global
Typical Low
$60.26
Median
$125.89
Typical High
$125.89
United
Setting
Professional
Modifier
Global
Typical Low
$107.15
Median
$190.55
Typical High
$389.05