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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 October 2026.

How much does GRAFTJACKET cost?

$151

Typical negotiated rate. In North Dakota, October 2026.

Insurers have agreed to pay about $151 for this service. The price depends on where it is billed: about $151 from a physician practice, and about $81.28 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 5 insurance carriers under federal price transparency rules.

Prices by location type

Billed byTypicalRange
Physician practiceA doctor's office, clinic or independent provider$151$115 to $275
FacilityA hospital or hospital-owned outpatient department$81.28$81.28 to $100

How much rates vary

Facilitymedian $81 · 10th to 90th $81 to $141Professionalmedian $151 · 10th to 90th $91 to $295
$100$200facility $81professional $151

Distribution of negotiated rates across all payers (price axis is log-scale). Small sample; interpret with caution. 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
$81.28
Aetna
Setting
Professional
Modifier
None
Typical Low
$81.28
Median
$81.28
Typical High
$100.00
BCBS North Dakota
Setting
Professional
Modifier
None
Typical Low
$223.87
Median
$269.15
Typical High
$323.59
BCBS North Dakota
Setting
Professional
Modifier
22 · Increased work
Typical Low
$269.15
Median
$323.59
Typical High
$389.05
Cigna
Setting
Facility
Modifier
None
Typical Low
$144.54
Median
$144.54
Typical High
$165.96
Cigna
Setting
Professional
Modifier
None
Typical Low
$91.20
Median
$114.82
Typical High
$117.49
Medica
Setting
Facility
Modifier
None
Typical Low
$81.28
Median
$81.28
Typical High
$138.04
Medica
Setting
Professional
Modifier
None
Typical Low
$138.04
Median
$138.04
Typical High
$151.36
United
Setting
Professional
Modifier
None
Typical Low
$120.23
Median
$125.89
Typical High
$141.25

Where North Dakota 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.

North Dakota· 1st of 51

$151

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.