go back

GRAFTJACKET

Idaho rates for HCPCS Q4107

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

Rates data updated July 2026.

Facilitymedian $117 · 10th–90th $85$2240%10%20%10th90th$117Professionalmedian $85 · 10th–90th $81$2190%50%10th90th$85$50.0$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
Facility
Modifier
Global
Typical Low
$117.49
Median
$117.49
Typical High
$117.49
Aetna
Setting
Professional
Modifier
Global
Typical Low
$81.28
Median
$83.18
Typical High
$117.49
BCBS
Setting
Facility
Modifier
Global
Typical Low
$104.71
Median
$169.82
Typical High
$245.47
BCBS
Setting
Professional
Modifier
Global
Typical Low
$85.11
Median
$85.11
Typical High
$85.11
Cigna
Setting
Facility
Modifier
Global
Typical Low
$141.25
Median
$144.54
Typical High
$323.59
Cigna
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$125.89
Moda Health
Setting
Facility
Modifier
Global
Typical Low
$83.18
Median
$97.72
Typical High
$165.96
Moda Health
Setting
Professional
Modifier
Global
Typical Low
$141.25
Median
$218.78
Typical High
$251.19
Molina
Setting
Professional
Modifier
Global
Typical Low
$30.20
Median
$30.20
Typical High
$77.62
Regence BlueShield
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$151.36
Typical High
$151.36
Select Health
Setting
Facility
Modifier
Global
Typical Low
$117.49
Median
$120.23
Typical High
$295.12
Select Health
Setting
Professional
Modifier
Global
Typical Low
$123.03
Median
$147.91
Typical High
$234.42
United
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$125.89