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GRAFTJACKET

Washington, DC rates for HCPCS Q4107

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

Rates data updated July 2026.

Facilitymedian $85 · 10th–90th $85$2630%50%90th$85Professionalmedian $85 · 10th–90th $83$1260%50%10th90th$85$100.0$200.0$500.0

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Small sample; interpret with caution. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Setting
Facility
Modifier
Global
Typical Low
$85.11
Median
$85.11
Typical High
$85.11
Aetna
Setting
Professional
Modifier
Global
Typical Low
$83.18
Median
$85.11
Typical High
$85.11
CareFirst
Setting
Professional
Modifier
Global
Typical Low
$104.71
Median
$104.71
Typical High
$104.71
Cigna
Setting
Facility
Modifier
Global
Typical Low
$194.98
Median
$263.03
Typical High
$446.68
Cigna
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$125.89
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$114.82
Median
$123.03
Typical High
$162.18
United
Setting
Professional
Modifier
Global
Typical Low
$100.00
Median
$125.89
Typical High
$158.49