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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 July 2026.

Facilitymedian $102 · 10th–90th $81$2240%20%10th90th$102Professionalmedian $98 · 10th–90th $81$1380%20%10th90th$98$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
$107.15
Aetna
Setting
Professional
Modifier
Global
Typical Low
$81.28
Median
$81.28
Typical High
$85.11
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$93.33
Median
$109.65
Typical High
$131.83
BCBS
Setting
Professional
Modifier
Global
Typical Low
$123.03
Median
$144.54
Typical High
$194.98
Cigna
Setting
Facility
Modifier
Global
Typical Low
$144.54
Median
$239.88
Typical High
$371.54
Cigna
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$125.89
Medica
Setting
Facility
Modifier
Global
Typical Low
$81.28
Median
$100.00
Typical High
$218.78
Medica
Setting
Professional
Modifier
Global
Typical Low
$114.82
Median
$138.04
Typical High
$851.14
United
Setting
Facility
Modifier
Global
Typical Low
$102.33
Median
$125.89
Typical High
$199.53
United
Setting
Professional
Modifier
Global
Typical Low
$100.00
Median
$125.89
Typical High
$128.82