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GRAFTJACKET

Georgia rates for HCPCS Q4107

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

Rates data updated July 2026.

Facilitymedian $129 · 10th–90th $83$3390%20%10th90th$129Professionalmedian $85 · 10th–90th $81$1290%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. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Setting
Facility
Modifier
Global
Typical Low
$83.18
Median
$83.18
Typical High
$128.82
Aetna
Setting
Professional
Modifier
Global
Typical Low
$81.28
Median
$83.18
Typical High
$100.00
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$95.50
Median
$128.82
Typical High
$128.82
Cigna
Setting
Facility
Modifier
Global
Typical Low
$144.54
Median
$234.42
Typical High
$338.84
Cigna
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$144.54
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$100.00
Median
$128.82
Typical High
$257.04
Oscar Health
Setting
Professional
Modifier
Global
Typical Low
$194.98
Median
$194.98
Typical High
$239.88
United
Setting
Facility
Modifier
Global
Typical Low
$125.89
Median
$245.47
Typical High
$346.74
United
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$141.25