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GRAFTJACKET

North Dakota rates for HCPCS Q4107

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

Rates data updated July 2026.

Facilitymedian $93 · 10th–90th $81$1260%20%40%10th90th$93Professionalmedian $83 · 10th–90th $66$1150%20%40%10th90th$83$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
$100.00
Aetna
Setting
Professional
Modifier
Global
Typical Low
$81.28
Median
$83.18
Typical High
$100.00
BCBS
Setting
Professional
Modifier
Global
Typical Low
$64.57
Median
$74.13
Typical High
$95.50
Cigna
Setting
Facility
Modifier
Global
Typical Low
$144.54
Median
$144.54
Typical High
$165.96
Cigna
Setting
Professional
Modifier
Global
Typical Low
$91.20
Median
$114.82
Typical High
$125.89
Medica
Setting
Facility
Modifier
Global
Typical Low
$81.28
Median
$100.00
Typical High
$141.25
Medica
Setting
Professional
Modifier
Global
Typical Low
$138.04
Median
$138.04
Typical High
$151.36
United
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$239.88