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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 October 2026.

How much does GRAFTJACKET cost?

$120

Typical negotiated rate. In Hawaii, October 2026.

Insurers have agreed to pay about $120 for this service. Most negotiated rates run $105 to $129.

These are rates insurers have negotiated with providers, not the amount a patient is billed. What you owe depends on your plan's deductible and coinsurance. Based on rates published by 6 insurance carriers under federal price transparency rules.

How much rates vary

Professionalmedian $120 · 10th to 90th $93 to $158
$100$200professional $120

Distribution of negotiated rates across all payers (price axis is log-scale). Need provider-level prices or 24+ months of history? Contact us.

Rates by insurance carrier

Insurance Carrier
Aetna
Setting
Professional
Modifier
None
Typical Low
$83.18
Median
$85.11
Typical High
$85.11
Cigna
Setting
Professional
Modifier
None
Typical Low
$123.03
Median
$125.89
Typical High
$125.89
HMSA
Setting
Professional
Modifier
None
Typical Low
$93.33
Median
$104.71
Typical High
$120.23
Kaiser Permanente
Setting
Professional
Modifier
None
Typical Low
$154.88
Median
$158.49
Typical High
$204.17
United
Setting
Professional
Modifier
None
Typical Low
$125.89
Median
$128.82
Typical High
$128.82
University Health Alliance
Setting
Professional
Modifier
None
Typical Low
$117.49
Median
$120.23
Typical High
$125.89

Where Hawaii sits

The same service costs 1.8 times more in North Dakota than in Virginia. Every bar is a state, most expensive first. Touch or drag across it to read any state, then open that state for its carriers and full range.

Hawaii· 30th of 51

$120

ND $151VA $85.11

Median negotiated rate in each state, from every insurer that publishes one. States where no insurer publishes a rate for this service are not shown.