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GRAFTJACKET

Indiana rates for HCPCS Q4107

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

Rates data updated July 2026.

How much does GRAFTJACKET cost?

$85.11

Typical negotiated rate. In Indiana, July 2026.

Insurers have agreed to pay about $85.11 for this service. The price depends on where it is billed: about $83.18 from a physician practice, and about $195 from a hospital or other facility. The two figures are alternatives, not parts of one bill.

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 4 insurance carriers under federal price transparency rules.

Where it's billed changes the price

Billed byTypicalRange
Physician practiceA doctor's office, clinic or independent provider$83.18$81.28 to $100
FacilityA hospital or hospital-owned outpatient department$195$115 to $380

How much rates vary

Facilitymedian $195 · 10th to 90th $81 to $513Professionalmedian $83 · 10th to 90th $81 to $126
$100$200$500facility $195professional $83

Distribution of negotiated rates across all payers (price axis is log-scale). Each curve is scaled to its own total: facility and professional rates are different services, shown together to compare where they cluster. Need provider-level prices or 24+ months of history? Contact us.

Rates by insurance carrier

Insurance Carrier
Aetna
Setting
Facility
Modifier
Global
Typical Low
$81.28
Median
$81.28
Typical High
$81.28
Aetna
Setting
Professional
Modifier
Global
Typical Low
$81.28
Median
$81.28
Typical High
$85.11
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$109.65
Median
$213.80
Typical High
$512.86
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$85.11
Median
$93.33
Typical High
$144.54
Cigna
Setting
Facility
Modifier
Global
Typical Low
$141.25
Median
$346.74
Typical High
$346.74
Cigna
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$125.89
United
Setting
Facility
Modifier
Global
Typical Low
$102.33
Median
$257.04
Typical High
$257.04
United
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$131.83

Where Indiana sits

The same service costs 1.7 times more in Alaska than in New Mexico. 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.

Indiana· 34th of 51

$85.11

AK $138NM $83.18

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.