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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 October 2026.

How much does GRAFTJACKET cost?

$117

Typical negotiated rate. In South Carolina, October 2026.

Insurers have agreed to pay about $117 for this service. The price depends on where it is billed: about $117 from a physician practice, and about $166 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 6 insurance carriers under federal price transparency rules.

Prices by location type

Billed byTypicalRange
Physician practiceA doctor's office, clinic or independent provider$117$83.18 to $126
FacilityA hospital or hospital-owned outpatient department$166$145 to $240

How much rates vary

Facilitymedian $166 · 10th to 90th $100 to $309Professionalmedian $117 · 10th to 90th $50 to $148
$100$200$500$1K$2Kfacility $166professional $117

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
$83.18
Median
$83.18
Typical High
$83.18
Aetna
Setting
Professional
Modifier
None
Typical Low
$83.18
Median
$83.18
Typical High
$85.11
BCBS South Carolina
Setting
Facility
Modifier
None
Typical Low
$138.04
Median
$234.42
Typical High
$4,073.80
BCBS South Carolina
Setting
Professional
Modifier
None
Typical Low
$50.12
Median
$117.49
Typical High
$147.91
Cigna
Setting
Facility
Modifier
None
Typical Low
$144.54
Median
$177.83
Typical High
$309.03
Cigna
Setting
Professional
Modifier
None
Typical Low
$125.89
Median
$125.89
Typical High
$125.89
Medcost
Setting
Facility
Modifier
None
Typical Low
$83.18
Median
$100.00
Typical High
$117.49
Medcost
Setting
Professional
Modifier
None
Typical Low
$81.28
Median
$91.20
Typical High
$112.20
Molina
Setting
Professional
Modifier
None
Typical Low
$83.18
Median
$83.18
Typical High
$87.10
United
Setting
Professional
Modifier
None
Typical Low
$107.15
Median
$125.89
Typical High
$125.89
5 more rates with less common billing modifiers

A modifier changes what was billed, for example a reduced or repeated service. Each of these modifiers carries under 10% of the published rates for this code. Modifier combinations, and modifiers with fewer than 30 rates for a carrier, are not listed.

Insurance Carrier
Medcost
Setting
Professional
Modifier
51 · Multiple procedures
Typical Low
$44.67
Median
$45.71
Typical High
$74.13
Medcost
Setting
Professional
Modifier
80 · Assistant surgeon
Typical Low
$17.78
Median
$18.62
Typical High
$29.51
Medcost
Setting
Professional
Modifier
81 · Minimal assistant surgeon
Typical Low
$12.59
Median
$12.88
Typical High
$20.42
Medcost
Setting
Professional
Modifier
82 · Assistant surgeon, no resident
Typical Low
$12.59
Median
$12.88
Typical High
$20.42
Medcost
Setting
Professional
Modifier
AS · PA/NP assist
Typical Low
$12.59
Median
$12.88
Typical High
$20.42

Where South Carolina 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.

South Carolina· 31st of 51

$117

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.