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SurGraft

Ohio rates for HCPCS Q4209

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

Rates data updated October 2026.

How much does SurGraft cost?

$126

Typical negotiated rate. In Ohio, October 2026.

Insurers have agreed to pay about $126 for this service. The price depends on where it is billed: about $126 from a physician practice, and about $275 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$126 to $162
FacilityA hospital or hospital-owned outpatient department$275$240 to $347

How much rates vary

Facilitymedian $275 · 10th to 90th $141 to $389Professionalmedian $126 · 10th to 90th $112 to $347
$100$200facility $275professional $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
$346.74
Median
$346.74
Typical High
$346.74
Aetna
Setting
Professional
Modifier
None
Typical Low
$125.89
Median
$346.74
Typical High
$346.74
Aetna
Setting
Professional
Modifier
52 · Reduced service
Typical Low
$63.10
Median
$173.78
Typical High
$173.78
Aetna
Setting
Professional
Modifier
53 · Discontinued
Typical Low
$25.12
Median
$70.79
Typical High
$70.79
Aetna
Setting
Professional
Modifier
55 · Aftercare only
Typical Low
$19.05
Median
$52.48
Typical High
$52.48
Aetna
Setting
Professional
Modifier
56 · Pre-op care only
Typical Low
$12.59
Median
$34.67
Typical High
$34.67
Anthem BCBS
Setting
Professional
Modifier
None
Typical Low
$120.23
Median
$158.49
Typical High
$199.53
Cigna
Setting
Facility
Modifier
None
Typical Low
$239.88
Median
$275.42
Typical High
$416.87
Cigna
Setting
Professional
Modifier
None
Typical Low
$125.89
Median
$125.89
Typical High
$125.89
Medical Mutual of Ohio
Setting
Facility
Modifier
None
Typical Low
$239.88
Median
$275.42
Typical High
$363.08
Medical Mutual of Ohio
Setting
Professional
Modifier
None
Typical Low
$125.89
Median
$125.89
Typical High
$125.89
Molina
Setting
Professional
Modifier
None
Typical Low
$50.12
Median
$87.10
Typical High
$102.33
SummaCare
Setting
Facility
Modifier
None
Typical Low
$134.90
Median
$141.25
Typical High
$158.49
SummaCare
Setting
Professional
Modifier
None
Typical Low
$109.65
Median
$123.03
Typical High
$151.36
United
Setting
Professional
Modifier
None
Typical Low
$117.49
Median
$125.89
Typical High
$151.36

Where Ohio sits

The same service costs 2.3 times more in North Dakota than in North Carolina. 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.

Ohio· 17th of 51

$126

ND $224NC $97.72

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.