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GRAFTJACKET

Iowa rates for HCPCS Q4107

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

Rates data updated July 2026.

Facilitymedian $91 · 10th–90th $91$1380%50%90th$91Professionalmedian $100 · 10th–90th $81$1380%20%40%10th90th$100$0.2$1.0$5.0$20.0$100.0$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
$100.00
Median
$100.00
Typical High
$100.00
Aetna
Setting
Professional
Modifier
Global
Typical Low
$81.28
Median
$100.00
Typical High
$100.00
Cigna
Setting
Facility
Modifier
Global
Typical Low
$177.83
Median
$223.87
Typical High
$269.15
Cigna
Setting
Professional
Modifier
Global
Typical Low
$91.20
Median
$114.82
Typical High
$134.90
Hally Health
Setting
Professional
Modifier
Global
Typical Low
$120.23
Median
$208.93
Typical High
$263.03
Medica
Setting
Facility
Modifier
Global
Typical Low
$81.28
Median
$104.71
Typical High
$177.83
Medica
Setting
Professional
Modifier
Global
Typical Low
$117.49
Median
$138.04
Typical High
$204.17
Midlands
Setting
Professional
Modifier
Global
Typical Low
$91.20
Median
$128.82
Typical High
$165.96
Midlands
Setting
Facility
Modifier
Global
Typical Low
$165.96
Median
$208.93
Typical High
$269.15
Midlands
Setting
Professional
Modifier
Global
Typical Low
$112.20
Median
$199.53
Typical High
$199.53
United
Setting
Facility
Modifier
Global
Typical Low
$0.13
Median
$114.82
Typical High
$208.93
United
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$138.04
Wellmark
Setting
Facility
Modifier
Global
Typical Low
$91.20
Median
$91.20
Typical High
$91.20
Wellmark
Setting
Professional
Modifier
Global
Typical Low
$72.44
Median
$91.20
Typical High
$91.20