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GRAFTJACKET

South Dakota 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 Dakota, October 2026.

Insurers have agreed to pay about $117 for this service. The price depends on where it is billed: about $126 from a physician practice, and about $91.20 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$126$91.20 to $138
FacilityA hospital or hospital-owned outpatient department$91.20$91.20 to $155

How much rates vary

Facilitymedian $91 · 10th to 90th $91 to $162Professionalmedian $126 · 10th to 90th $85 to $141
$100$200$500facility $91professional $126

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
$100.00
Aetna
Setting
Professional
Modifier
None
Typical Low
$85.11
Median
$85.11
Typical High
$100.00
Cigna
Setting
Facility
Modifier
None
Typical Low
$123.03
Median
$154.88
Typical High
$169.82
Cigna
Setting
Professional
Modifier
None
Typical Low
$91.20
Median
$114.82
Typical High
$134.90
Medica
Setting
Facility
Modifier
None
Typical Low
$100.00
Median
$154.88
Typical High
$165.96
Medica
Setting
Professional
Modifier
None
Typical Low
$114.82
Median
$138.04
Typical High
$851.14
Midlands
Setting
Professional
Modifier
None
Typical Low
$134.90
Median
$134.90
Typical High
$134.90
Midlands
Setting
Facility
Modifier
None
Typical Low
$162.18
Median
$162.18
Typical High
$204.17
Midlands
Setting
Professional
Modifier
None
Typical Low
$117.49
Median
$117.49
Typical High
$204.17
Sanford Health Plan
Setting
Professional
Modifier
None
Typical Low
$85.11
Median
$85.11
Typical High
$85.11
United
Setting
Professional
Modifier
None
Typical Low
$120.23
Median
$125.89
Typical High
$141.25
Wellmark
Setting
Facility
Modifier
None
Typical Low
$91.20
Median
$91.20
Typical High
$91.20
Wellmark
Setting
Professional
Modifier
None
Typical Low
$91.20
Median
$91.20
Typical High
$91.20

Where South Dakota 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 Dakota· 32nd 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.