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GRAFTJACKET

Massachusetts 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 $85$2750%20%10th90th$110Professionalmedian $93 · 10th–90th $83$1350%20%10th90th$93$100.0$500.0$2.0K$10.0K$50.0K

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
$85.11
Median
$85.11
Typical High
$85.11
Aetna
Setting
Professional
Modifier
Global
Typical Low
$81.28
Median
$85.11
Typical High
$100.00
AllWays Health Partners
Setting
Facility
Modifier
Global
Typical Low
$85.11
Median
$91.20
Typical High
$707.95
AllWays Health Partners
Setting
Professional
Modifier
Global
Typical Low
$107.15
Median
$125.89
Typical High
$263.03
BCBS
Setting
Facility
Modifier
Global
Typical Low
$95.50
Median
$95.50
Typical High
$190.55
Cigna
Setting
Facility
Modifier
Global
Typical Low
$151.36
Median
$229.09
Typical High
$549.54
Cigna
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$125.89
Fallon Health
Setting
Facility
Modifier
Global
Typical Low
$93.33
Median
$181.97
Typical High
$1,995.26
Fallon Health
Setting
Professional
Modifier
Global
Typical Low
$128.82
Median
$181.97
Typical High
$263.03
Harvard Pilgrim
Setting
Professional
Modifier
Global
Typical Low
$93.33
Median
$93.33
Typical High
$125.89
Mass General Brigham
Setting
Facility
Modifier
Global
Typical Low
$85.11
Median
$91.20
Typical High
$707.95
Mass General Brigham
Setting
Professional
Modifier
Global
Typical Low
$107.15
Median
$125.89
Typical High
$263.03
United
Setting
Facility
Modifier
Global
Typical Low
$125.89
Median
$208.93
Typical High
$275.42
United
Setting
Professional
Modifier
Global
Typical Low
$93.33
Median
$100.00
Typical High
$125.89