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GRAFTJACKET

Tennessee rates for HCPCS Q4107

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

Rates data updated July 2026.

Facilitymedian $195 · 10th–90th $102$7080%20%10th90th$195Professionalmedian $83 · 10th–90th $81$1260%50%10th90th$83$100.0$200.0$500.0

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
$147.91
Aetna
Setting
Professional
Modifier
Global
Typical Low
$81.28
Median
$83.18
Typical High
$85.11
BCBS
Setting
Professional
Modifier
Global
Typical Low
$91.20
Median
$95.50
Typical High
$95.50
Cigna
Setting
Facility
Modifier
Global
Typical Low
$138.04
Median
$186.21
Typical High
$223.87
Cigna
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$125.89
Lucent Health
Setting
Facility
Modifier
Global
Typical Low
$707.95
Median
$707.95
Typical High
$707.95
Lucent Health
Setting
Professional
Modifier
Global
Typical Low
$851.14
Median
$851.14
Typical High
$851.14
United
Setting
Facility
Modifier
Global
Typical Low
$125.89
Median
$134.90
Typical High
$275.42
United
Setting
Professional
Modifier
Global
Typical Low
$114.82
Median
$125.89
Typical High
$125.89