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GRAFTJACKET

Kentucky rates for HCPCS Q4107

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

Rates data updated July 2026.

Facilitymedian $110 · 10th–90th $105$1100%50%10th$110Professionalmedian $85 · 10th–90th $81$1260%50%10th90th$85$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
$104.71
Median
$109.65
Typical High
$109.65
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$89.13
Median
$93.33
Typical High
$93.33
Cigna
Setting
Facility
Modifier
Global
Typical Low
$151.36
Median
$173.78
Typical High
$173.78
Cigna
Setting
Professional
Modifier
Global
Typical Low
$120.23
Median
$125.89
Typical High
$616.60
Molina
Setting
Professional
Modifier
Global
Typical Low
$44.67
Median
$44.67
Typical High
$158.49
United
Setting
Facility
Modifier
Global
Typical Low
$102.33
Median
$102.33
Typical High
$138.04
United
Setting
Professional
Modifier
Global
Typical Low
$114.82
Median
$125.89
Typical High
$125.89