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GRAFTJACKET

Maine rates for HCPCS Q4107

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

Rates data updated July 2026.

Facilitymedian $145 · 10th–90th $145$3630%50%90th$145Professionalmedian $85 · 10th–90th $81$1120%20%40%10th90th$85$100.0$200.0

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Small sample; interpret with caution. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Setting
Professional
Modifier
Global
Typical Low
$69.18
Median
$85.11
Typical High
$85.11
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$81.28
Median
$85.11
Typical High
$95.50
Cigna
Setting
Facility
Modifier
Global
Typical Low
$144.54
Median
$144.54
Typical High
$363.08
Cigna
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$125.89
Harvard Pilgrim
Setting
Professional
Modifier
Global
Typical Low
$93.33
Median
$93.33
Typical High
$112.20
Martin's Point
Setting
Professional
Modifier
Global
Typical Low
$81.28
Median
$85.11
Typical High
$120.23
United
Setting
Professional
Modifier
Global
Typical Low
$93.33
Median
$97.72
Typical High
$125.89