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GRAFTJACKET

New York rates for HCPCS Q4107

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

Rates data updated July 2026.

Facilitymedian $85 · 10th–90th $81$1740%50%10th90th$85Professionalmedian $95 · 10th–90th $81$1260%50%10th90th$95$50.0$200.0$1.0K$5.0K$20.0K

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
$69.18
Median
$81.28
Typical High
$144.54
Aetna
Setting
Professional
Modifier
Global
Typical Low
$81.28
Median
$83.18
Typical High
$89.13
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$95.50
Median
$95.50
Typical High
$95.50
Cigna
Setting
Facility
Modifier
Global
Typical Low
$97.72
Median
$165.96
Typical High
$186.21
Cigna
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$144.54
Emblem Health
Setting
Facility
Modifier
Global
Typical Low
$104.71
Median
$158.49
Typical High
$416.87
Emblem Health
Setting
Professional
Modifier
Global
Typical Low
$100.00
Median
$100.00
Typical High
$162.18
Excellus BCBS
Setting
Facility
Modifier
Global
Typical Low
$85.11
Median
$85.11
Typical High
$85.11
Excellus BCBS
Setting
Professional
Modifier
Global
Typical Low
$85.11
Median
$85.11
Typical High
$85.11
MVP Health Care
Setting
Facility
Modifier
Global
Typical Low
$186.21
Median
$50,118.72
Typical High
$75,857.76
MVP Health Care
Setting
Professional
Modifier
Global
Typical Low
$114.82
Median
$114.82
Typical High
$346.74
United
Setting
Facility
Modifier
Global
Typical Low
$125.89
Median
$138.04
Typical High
$208.93
United
Setting
Professional
Modifier
Global
Typical Low
$95.50
Median
$100.00
Typical High
$134.90
Univera
Setting
Facility
Modifier
Global
Typical Low
$85.11
Median
$85.11
Typical High
$97.72
Univera
Setting
Professional
Modifier
Global
Typical Low
$85.11
Median
$85.11
Typical High
$85.11