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GRAFTJACKET

Texas rates for HCPCS Q4107

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

Rates data updated July 2026.

Facilitymedian $145 · 10th–90th $83$5010%20%10th90th$145Professionalmedian $83 · 10th–90th $81$1260%50%10th90th$83$2.0$10.0$50.0$200.0$1.0K$5.0K

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
$81.28
Median
$83.18
Typical High
$141.25
Aetna
Setting
Professional
Modifier
Global
Typical Low
$81.28
Median
$83.18
Typical High
$85.11
BCBS
Setting
Facility
Modifier
Global
Typical Low
$107.15
Median
$263.03
Typical High
$489.78
Christus
Setting
Facility
Modifier
Global
Typical Low
$79.43
Median
$120.23
Typical High
$125.89
Cigna
Setting
Facility
Modifier
Global
Typical Low
$125.89
Median
$309.03
Typical High
$851.14
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
Moda Health
Setting
Facility
Modifier
Global
Typical Low
$83.18
Median
$93.33
Typical High
$194.98
Moda Health
Setting
Professional
Modifier
Global
Typical Low
$141.25
Median
$190.55
Typical High
$234.42
Molina
Setting
Professional
Modifier
Global
Typical Low
$32.36
Median
$32.36
Typical High
$33.11
Oscar Health
Setting
Professional
Modifier
Global
Typical Low
$204.17
Median
$204.17
Typical High
$302.00
Providence
Setting
Facility
Modifier
Global
Typical Low
$83.18
Median
$112.20
Typical High
$213.80
Providence
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$125.89
United
Setting
Facility
Modifier
Global
Typical Low
$102.33
Median
$125.89
Typical High
$208.93
United
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$125.89
Wellpoint
Setting
Professional
Modifier
Global
Typical Low
$81.28
Median
$120.23
Typical High
$169.82