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GRAFTJACKET

Hawaii rates for HCPCS Q4107

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

Rates data updated July 2026.

Professionalmedian $93 · 10th–90th $81$1290%20%40%10th90th$93$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
Professional
Modifier
Global
Typical Low
$81.28
Median
$83.18
Typical High
$85.11
Cigna
Setting
Professional
Modifier
Global
Typical Low
$123.03
Median
$125.89
Typical High
$125.89
HMSA
Setting
Professional
Modifier
Global
Typical Low
$104.71
Median
$104.71
Typical High
$125.89
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$144.54
Median
$173.78
Typical High
$218.78
United
Setting
Professional
Modifier
Global
Typical Low
$114.82
Median
$125.89
Typical High
$128.82