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GRAFTJACKET

Nebraska 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?

$126

Typical negotiated rate. In Nebraska, October 2026.

Insurers have agreed to pay about $126 for this service. The price depends on where it is billed: about $126 from a physician practice, and about $105 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$126$105 to $138
FacilityA hospital or hospital-owned outpatient department$105$100 to $234

How much rates vary

Facilitymedian $105 · 10th to 90th $89 to $3,236Professionalmedian $126 · 10th to 90th $81 to $145
$100$200$500$1K$2K$5Kfacility $105professional $126

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
$81.28
BCBS Nebraska
Setting
Facility
Modifier
None
Typical Low
$87.10
Median
$104.71
Typical High
$3,548.13
BCBS Nebraska
Setting
Professional
Modifier
None
Typical Low
$100.00
Median
$104.71
Typical High
$104.71
Cigna
Setting
Facility
Modifier
None
Typical Low
$190.55
Median
$208.93
Typical High
$234.42
Cigna
Setting
Professional
Modifier
None
Typical Low
$87.10
Median
$134.90
Typical High
$173.78
Medica
Setting
Facility
Modifier
None
Typical Low
$81.28
Median
$154.88
Typical High
$380.19
Medica
Setting
Professional
Modifier
None
Typical Low
$123.03
Median
$138.04
Typical High
$151.36
Midlands
Setting
Professional
Modifier
None
Typical Low
$117.49
Median
$134.90
Typical High
$190.55
Midlands
Setting
Facility
Modifier
None
Typical Low
$190.55
Median
$208.93
Typical High
$331.13
Midlands
Setting
Professional
Modifier
None
Typical Low
$81.28
Median
$117.49
Typical High
$162.18
United
Setting
Professional
Modifier
None
Typical Low
$114.82
Median
$125.89
Typical High
$134.90

Where Nebraska 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.

Nebraska· 22nd of 51

$126

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.