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GRAFTJACKET

Connecticut rates for HCPCS Q4107

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

Rates data updated July 2026.

Facilitymedian $145 · 10th–90th $85$2880%20%10th90th$145Professionalmedian $85 · 10th–90th $81$1260%50%10th90th$85$100.0$200.0

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
$85.11
Median
$138.04
Typical High
$288.40
Aetna
Setting
Professional
Modifier
Global
Typical Low
$81.28
Median
$85.11
Typical High
$85.11
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$81.28
Median
$85.11
Typical High
$117.49
Cigna
Setting
Facility
Modifier
Global
Typical Low
$141.25
Median
$144.54
Typical High
$245.47
Cigna
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$125.89
ConnectiCare
Setting
Professional
Modifier
Global
Typical Low
$100.00
Median
$100.00
Typical High
$147.91
United
Setting
Facility
Modifier
Global
Typical Low
$83.18
Median
$83.18
Typical High
$83.18
United
Setting
Professional
Modifier
Global
Typical Low
$100.00
Median
$125.89
Typical High
$134.90