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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 October 2026.

How much does GRAFTJACKET cost?

$93.33

Typical negotiated rate. In Indiana, October 2026.

Insurers have agreed to pay about $93.33 for this service. The price depends on where it is billed: about $93.33 from a physician practice, and about $195 from a hospital or other facility.

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 5 insurance carriers under federal price transparency rules.

Prices by location type

Billed byTypicalRange
Physician practiceA doctor's office, clinic or independent provider$93.33$93.33 to $126
FacilityA hospital or hospital-owned outpatient department$195$141 to $282

How much rates vary

Facilitymedian $195 · 10th to 90th $126 to $417Professionalmedian $93 · 10th to 90th $81 to $132
$100$200$500$1K$2Kfacility $195professional $93

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
Facility
Modifier
None
Typical Low
$81.28
Median
$81.28
Typical High
$81.28
Aetna
Setting
Professional
Modifier
None
Typical Low
$81.28
Median
$81.28
Typical High
$83.18
Anthem BCBS
Setting
Facility
Modifier
None
Typical Low
$125.89
Median
$181.97
Typical High
$501.19
Anthem BCBS
Setting
Professional
Modifier
None
Typical Low
$93.33
Median
$93.33
Typical High
$125.89
Cigna
Setting
Facility
Modifier
None
Typical Low
$144.54
Median
$229.09
Typical High
$346.74
Cigna
Setting
Professional
Modifier
None
Typical Low
$125.89
Median
$125.89
Typical High
$616.60
Physicians Health Plan of Northern Indiana
Setting
Facility
Modifier
None
Typical Low
$91.20
Median
$288.40
Typical High
$2,137.96
Physicians Health Plan of Northern Indiana
Setting
Professional
Modifier
None
Typical Low
$69.18
Median
$87.10
Typical High
$190.55
United
Setting
Professional
Modifier
None
Typical Low
$125.89
Median
$125.89
Typical High
$173.78

Where Indiana 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.

Indiana· 44th of 51

$93.33

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.