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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.

Facilitymedian $195 · 10th–90th $81$5130%10%10th90th$195Professionalmedian $83 · 10th–90th $81$1260%50%10th90th$83$20.0$50.0$100.0$200.0$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
$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