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SurGraft

Pennsylvania rates for HCPCS Q4209

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

Rates data updated July 2026.

How much does SurGraft cost?

$126

Typical negotiated rate. In Pennsylvania, July 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 $117 from a hospital or other facility. The two figures are alternatives, not parts of one bill.

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 6 insurance carriers under federal price transparency rules.

Where it's billed changes the price

Billed byTypicalRange
Physician practiceA doctor's office, clinic or independent provider$126$117 to $132
FacilityA hospital or hospital-owned outpatient department$117$93.33 to $126

How much rates vary

Facilitymedian $117 · 10th to 90th $93 to $468Professionalmedian $126 · 10th to 90th $98 to $155
$100.0$200.0$500.0facility $117professional $126

Distribution of negotiated rates across all payers (price axis is log-scale). Each curve is scaled to its own total: facility and professional rates are different services, shown together to compare where they cluster. Need provider-level prices or 24+ months of history? Contact us.

Rates by insurance carrier

Insurance Carrier
Aetna
Setting
Facility
Modifier
Global
Typical Low
$93.33
Median
$93.33
Typical High
$117.49
Aetna
Setting
Professional
Modifier
Global
Typical Low
$93.33
Median
$123.03
Typical High
$154.88
Cigna
Setting
Facility
Modifier
Global
Typical Low
$125.89
Median
$446.68
Typical High
$478.63
Cigna
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$125.89
Emblem Health
Setting
Professional
Modifier
Global
Typical Low
$154.88
Median
$218.78
Typical High
$263.03
Geisinger
Setting
Professional
Modifier
Global
Typical Low
$120.23
Median
$151.36
Typical High
$218.78
Martin's Point
Setting
Facility
Modifier
Global
Typical Low
$93.33
Median
$117.49
Typical High
$117.49
Martin's Point
Setting
Professional
Modifier
Global
Typical Low
$97.72
Median
$117.49
Typical High
$138.04
United
Setting
Facility
Modifier
Global
Typical Low
$154.88
Median
$154.88
Typical High
$154.88
United
Setting
Professional
Modifier
Global
Typical Low
$114.82
Median
$125.89
Typical High
$141.25

Where Pennsylvania sits

The same service costs 2.1 times more in Alaska than in Vermont. Every bar is a state, most expensive first. Pick one to see its carriers and full range.

Pennsylvania $126 · 36th of 51
AK $214VT $100

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.