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GRAFTJACKET

Delaware rates for HCPCS Q4107

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

Rates data updated July 2026.

Facilitymedian $617 · 10th–90th $145$15,8490%20%10th90th$617Professionalmedian $85 · 10th–90th $83$1260%50%10th90th$85$100.0$200.0$500.0$1.0K$2.0K$5.0K$10.0K

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
Professional
Modifier
Global
Typical Low
$83.18
Median
$85.11
Typical High
$85.11
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
Highmark BCBS
Setting
Facility
Modifier
Global
Typical Low
$616.60
Median
$616.60
Typical High
$15,848.93
United
Setting
Professional
Modifier
Global
Typical Low
$109.65
Median
$125.89
Typical High
$158.49