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GRAFTJACKET

New Jersey rates for HCPCS Q4107

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

Rates data updated July 2026.

Facilitymedian $145 · 10th–90th $85$15,4880%10%10th90th$145Professionalmedian $85 · 10th–90th $81$1260%50%10th90th$85$100.0$500.0$2.0K$10.0K

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
$85.11
Median
$109.65
Typical High
$112.20
Aetna
Setting
Professional
Modifier
Global
Typical Low
$81.28
Median
$83.18
Typical High
$85.11
Cigna
Setting
Facility
Modifier
Global
Typical Low
$72.44
Median
$95.50
Typical High
$151.36
Cigna
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$125.89
Emblem Health
Setting
Professional
Modifier
Global
Typical Low
$100.00
Median
$100.00
Typical High
$162.18
Horizon BCBS
Setting
Facility
Modifier
Global
Typical Low
$204.17
Median
$9,332.54
Typical High
$20,417.38
Horizon BCBS
Setting
Professional
Modifier
Global
Typical Low
$85.11
Median
$85.11
Typical High
$85.11
United
Setting
Facility
Modifier
Global
Typical Low
$125.89
Median
$154.88
Typical High
$316.23
United
Setting
Professional
Modifier
Global
Typical Low
$97.72
Median
$125.89
Typical High
$134.90