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GRAFTJACKET

Virginia 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?

$85.11

Typical negotiated rate. In Virginia, October 2026.

Insurers have agreed to pay about $85.11 for this service. The price depends on where it is billed: about $85.11 from a physician practice, and about $151 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 8 insurance carriers under federal price transparency rules.

Prices by location type

Billed byTypicalRange
Physician practiceA doctor's office, clinic or independent provider$85.11$81.28 to $126
FacilityA hospital or hospital-owned outpatient department$151$95.50 to $240

How much rates vary

Facilitymedian $151 · 10th to 90th $85 to $316Professionalmedian $85 · 10th to 90th $81 to $126
$100$200facility $151professional $85

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
$85.11
Median
$85.11
Typical High
$85.11
Aetna
Setting
Professional
Modifier
None
Typical Low
$85.11
Median
$85.11
Typical High
$85.11
Anthem BCBS
Setting
Professional
Modifier
None
Typical Low
$81.28
Median
$81.28
Typical High
$83.18
CareFirst
Setting
Professional
Modifier
None
Typical Low
$104.71
Median
$104.71
Typical High
$104.71
Cigna
Setting
Facility
Modifier
None
Typical Low
$138.04
Median
$223.87
Typical High
$331.13
Cigna
Setting
Professional
Modifier
None
Typical Low
$125.89
Median
$125.89
Typical High
$125.89
Kaiser Permanente
Setting
Professional
Modifier
None
Typical Low
$120.23
Median
$138.04
Typical High
$194.98
Medcost
Setting
Professional
Modifier
None
Typical Low
$89.13
Median
$89.13
Typical High
$89.13
Medcost
Setting
Facility
Modifier
None
Typical Low
$85.11
Median
$100.00
Typical High
$165.96
Medcost
Setting
Professional
Modifier
None
Typical Low
$91.20
Median
$100.00
Typical High
$109.65
Sentara
Setting
Facility
Modifier
None
Typical Low
$81.28
Median
$89.13
Typical High
$95.50
Sentara
Setting
Professional
Modifier
None
Typical Low
$83.18
Median
$83.18
Typical High
$95.50
United
Setting
Professional
Modifier
None
Typical Low
$125.89
Median
$125.89
Typical High
$134.90

Where Virginia 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.

Virginia· 51st of 51

$85.11

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.