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GRAFTJACKET

California rates for HCPCS Q4107

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

Rates data updated July 2026.

Facilitymedian $110 · 10th–90th $85$2750%20%40%10th90th$110Professionalmedian $85 · 10th–90th $81$1860%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
$83.18
Median
$83.18
Typical High
$83.18
Aetna
Setting
Professional
Modifier
Global
Typical Low
$81.28
Median
$83.18
Typical High
$100.00
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$85.11
Median
$107.15
Typical High
$275.42
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$85.11
Median
$97.72
Typical High
$162.18
Blue Shield
Setting
Facility
Modifier
Global
Typical Low
$95.50
Median
$147.91
Typical High
$269.15
Blue Shield
Setting
Professional
Modifier
Global
Typical Low
$70.79
Median
$89.13
Typical High
$123.03
Cigna
Setting
Facility
Modifier
Global
Typical Low
$131.83
Median
$218.78
Typical High
$295.12
Cigna
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$125.89
Contra Costa Health
Setting
Professional
Modifier
Global
Typical Low
$95.50
Median
$114.82
Typical High
$239.88
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$131.83
Median
$169.82
Typical High
$269.15
Lucent Health
Setting
Facility
Modifier
Global
Typical Low
$707.95
Median
$707.95
Typical High
$707.95
Lucent Health
Setting
Professional
Modifier
Global
Typical Low
$851.14
Median
$851.14
Typical High
$851.14
Molina
Setting
Professional
Modifier
Global
Typical Low
$97.72
Median
$97.72
Typical High
$104.71
Providence
Setting
Facility
Modifier
Global
Typical Low
$85.11
Median
$125.89
Typical High
$229.09
Providence
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$125.89
The Alliance
Setting
Professional
Modifier
Global
Typical Low
$95.50
Median
$144.54
Typical High
$165.96
United
Setting
Facility
Modifier
Global
Typical Low
$467.74
Median
$467.74
Typical High
$467.74
United
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$199.53