go back

GRAFTJACKET

New York 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?

$95.50

Typical negotiated rate. In New York, October 2026.

Insurers have agreed to pay about $95.50 for this service. The price depends on where it is billed: about $95.50 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 8 insurance carriers under federal price transparency rules.

Prices by location type

Billed byTypicalRange
Physician practiceA doctor's office, clinic or independent provider$95.50$95.50 to $126
FacilityA hospital or hospital-owned outpatient department$105$85.11 to $186

How much rates vary

Facilitymedian $105 · 10th to 90th $85 to $309Professionalmedian $95 · 10th to 90th $69 to $135
$100$200$500facility $105professional $95

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
$69.18
Median
$81.28
Typical High
$85.11
Aetna
Setting
Professional
Modifier
None
Typical Low
$69.18
Median
$69.18
Typical High
$81.28
Anthem BCBS
Setting
Professional
Modifier
None
Typical Low
$95.50
Median
$95.50
Typical High
$95.50
Cigna
Setting
Facility
Modifier
None
Typical Low
$134.90
Median
$186.21
Typical High
$363.08
Cigna
Setting
Professional
Modifier
None
Typical Low
$125.89
Median
$125.89
Typical High
$125.89
Emblem Health
Setting
Facility
Modifier
None
Typical Low
$104.71
Median
$154.88
Typical High
$446.68
Emblem Health
Setting
Professional
Modifier
None
Typical Low
$100.00
Median
$100.00
Typical High
$158.49
Excellus BCBS
Setting
Facility
Modifier
None
Typical Low
$85.11
Median
$85.11
Typical High
$85.11
Excellus BCBS
Setting
Professional
Modifier
None
Typical Low
$85.11
Median
$85.11
Typical High
$85.11
MVP Health Care
Setting
Facility
Modifier
None
Typical Low
$186.21
Median
$186.21
Typical High
$186.21
MVP Health Care
Setting
Professional
Modifier
None
Typical Low
$114.82
Median
$114.82
Typical High
$346.74
United
Setting
Professional
Modifier
None
Typical Low
$125.89
Median
$125.89
Typical High
$165.96
Univera
Setting
Facility
Modifier
None
Typical Low
$85.11
Median
$85.11
Typical High
$93.33
Univera
Setting
Professional
Modifier
None
Typical Low
$85.11
Median
$85.11
Typical High
$85.11

Where New York 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.

New York· 42nd of 51

$95.50

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.