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GRAFTJACKET

Minnesota rates for HCPCS Q4107

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

Rates data updated July 2026.

Facilitymedian $224 · 10th–90th $85$2880%10%20%10th90th$224Professionalmedian $107 · 10th–90th $72$1260%20%10th90th$107$0.2$1.0$5.0$20.0$100.0$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
$100.00
Median
$100.00
Typical High
$100.00
Aetna
Setting
Professional
Modifier
Global
Typical Low
$81.28
Median
$83.18
Typical High
$100.00
BCBS
Setting
Facility
Modifier
Global
Typical Low
$85.11
Median
$128.82
Typical High
$257.04
BCBS
Setting
Professional
Modifier
Global
Typical Low
$72.44
Median
$107.15
Typical High
$125.89
Cigna
Setting
Facility
Modifier
Global
Typical Low
$141.25
Median
$245.47
Typical High
$331.13
Cigna
Setting
Professional
Modifier
Global
Typical Low
$93.33
Median
$107.15
Typical High
$117.49
Health Partners
Setting
Facility
Modifier
Global
Typical Low
$165.96
Median
$234.42
Typical High
$346.74
Health Partners
Setting
Professional
Modifier
Global
Typical Low
$91.20
Median
$91.20
Typical High
$125.89
Medica
Setting
Facility
Modifier
Global
Typical Low
$93.33
Median
$93.33
Typical High
$131.83
Medica
Setting
Professional
Modifier
Global
Typical Low
$138.04
Median
$138.04
Typical High
$245.47
United
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$263.03