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GRAFTJACKET

Ohio 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?

$107

Typical negotiated rate. In Ohio, October 2026.

Insurers have agreed to pay about $107 for this service. The price depends on where it is billed: about $102 from a physician practice, and about $170 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 7 insurance carriers under federal price transparency rules.

Prices by location type

Billed byTypicalRange
Physician practiceA doctor's office, clinic or independent provider$102$93.33 to $126
FacilityA hospital or hospital-owned outpatient department$170$141 to $275

How much rates vary

Facilitymedian $170 · 10th to 90th $126 to $363Professionalmedian $102 · 10th to 90th $81 to $145
$100$200facility $170professional $102

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
$416.87
Aetna
Setting
Professional
Modifier
None
Typical Low
$81.28
Median
$81.28
Typical High
$144.54
Anthem BCBS
Setting
Professional
Modifier
None
Typical Low
$79.43
Median
$93.33
Typical High
$147.91
Cigna
Setting
Facility
Modifier
None
Typical Low
$125.89
Median
$194.98
Typical High
$389.05
Cigna
Setting
Professional
Modifier
None
Typical Low
$125.89
Median
$125.89
Typical High
$125.89
Medical Mutual of Ohio
Setting
Facility
Modifier
None
Typical Low
$125.89
Median
$177.83
Typical High
$316.23
Medical Mutual of Ohio
Setting
Professional
Modifier
None
Typical Low
$125.89
Median
$125.89
Typical High
$125.89
Molina
Setting
Professional
Modifier
None
Typical Low
$79.43
Median
$97.72
Typical High
$131.83
SummaCare
Setting
Facility
Modifier
None
Typical Low
$134.90
Median
$141.25
Typical High
$158.49
SummaCare
Setting
Professional
Modifier
None
Typical Low
$109.65
Median
$123.03
Typical High
$151.36
United
Setting
Professional
Modifier
None
Typical Low
$117.49
Median
$125.89
Typical High
$151.36

Where Ohio sits

The same service costs 1.8 times more in North Dakota than in New Jersey. 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.

Ohio· 34th of 51

$107

ND $151NJ $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.