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GRAFTJACKET

South Carolina rates for HCPCS Q4107

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

Rates data updated July 2026.

Facilitymedian $102 · 10th–90th $83$2040%20%10th90th$102Professionalmedian $83 · 10th–90th $81$1260%50%10th90th$83$50.0$100.0$200.0$500.0$1.0K$2.0K

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
$83.18
Median
$83.18
Typical High
$83.18
Aetna
Setting
Professional
Modifier
Global
Typical Low
$81.28
Median
$83.18
Typical High
$85.11
BCBS
Setting
Facility
Modifier
Global
Typical Low
$43.65
Median
$134.90
Typical High
$4,073.80
BCBS
Setting
Professional
Modifier
Global
Typical Low
$47.86
Median
$57.54
Typical High
$144.54
Cigna
Setting
Facility
Modifier
Global
Typical Low
$144.54
Median
$181.97
Typical High
$323.59
Cigna
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$125.89
Medcost
Setting
Facility
Modifier
Global
Typical Low
$83.18
Median
$102.33
Typical High
$204.17
Molina
Setting
Professional
Modifier
Global
Typical Low
$83.18
Median
$83.18
Typical High
$87.10
United
Setting
Facility
Modifier
Global
Typical Low
$102.33
Median
$125.89
Typical High
$208.93
United
Setting
Professional
Modifier
Global
Typical Low
$107.15
Median
$125.89
Typical High
$125.89