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GRAFTJACKET

Missouri rates for HCPCS Q4107

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

Rates data updated October 2026.

How much does GRAFTJACKET cost?

$123

Typical negotiated rate. In Missouri, October 2026.

Insurers have agreed to pay about $123 for this service. The price depends on where it is billed: about $123 from a physician practice, and about $166 from a hospital or other facility.

These are rates insurers have negotiated with providers, not the amount a patient is billed. What you owe depends on your plan's deductible and coinsurance. Based on rates published by 6 insurance carriers under federal price transparency rules.

Prices by location type

Billed byTypicalRange
Physician practiceA doctor's office, clinic or independent provider$123$110 to $132
FacilityA hospital or hospital-owned outpatient department$166$126 to $224

How much rates vary

Facilitymedian $166 · 10th to 90th $100 to $302Professionalmedian $123 · 10th to 90th $98 to $174
$100$200$500facility $166professional $123

Distribution of negotiated rates across all payers (price axis is log-scale). Need provider-level prices or 24+ months of history? Contact us.

Rates by insurance carrier

Insurance Carrier
Aetna
Setting
Facility
Modifier
None
Typical Low
$81.28
Median
$81.28
Typical High
$100.00
Aetna
Setting
Professional
Modifier
None
Typical Low
$81.28
Median
$81.28
Typical High
$83.18
Anthem BCBS
Setting
Professional
Modifier
None
Typical Low
$97.72
Median
$109.65
Typical High
$134.90
BCBS Kansas City
Setting
Professional
Modifier
None
Typical Low
$120.23
Median
$138.04
Typical High
$181.97
Cigna
Setting
Facility
Modifier
None
Typical Low
$125.89
Median
$190.55
Typical High
$269.15
Cigna
Setting
Professional
Modifier
None
Typical Low
$125.89
Median
$125.89
Typical High
$125.89
Medica
Setting
Facility
Modifier
None
Typical Low
$85.11
Median
$100.00
Typical High
$380.19
Medica
Setting
Professional
Modifier
None
Typical Low
$134.90
Median
$138.04
Typical High
$851.14
United
Setting
Professional
Modifier
None
Typical Low
$114.82
Median
$125.89
Typical High
$144.54

Where Missouri sits

The same service costs 1.8 times more in North Dakota than in Virginia. Every bar is a state, most expensive first. Touch or drag across it to read any state, then open that state for its carriers and full range.

Missouri· 28th of 51

$123

ND $151VA $85.11

Median negotiated rate in each state, from every insurer that publishes one. States where no insurer publishes a rate for this service are not shown.