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SurGraft

Utah 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 Utah, 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 $100 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 7 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 $138
FacilityA hospital or hospital-owned outpatient department$100$100 to $100

How much rates vary

Facilitymedian $100 · 10th to 90th $100 to $120Professionalmedian $126 · 10th to 90th $100 to $170
$50.0$100.0$200.0$500.0$1.0K$2.0K$5.0Kfacility $100professional $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
$100.00
Median
$100.00
Typical High
$100.00
Aetna
Setting
Professional
Modifier
Global
Typical Low
$100.00
Median
$125.89
Typical High
$154.88
Cigna
Setting
Facility
Modifier
Global
Typical Low
$144.54
Median
$144.54
Typical High
$446.68
Cigna
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$125.89
Molina
Setting
Professional
Modifier
Global
Typical Low
$30.20
Median
$44.67
Typical High
$60.26
Regence BlueShield
Setting
Professional
Modifier
Global
Typical Low
$123.03
Median
$141.25
Typical High
$162.18
Select Health
Setting
Facility
Modifier
Global
Typical Low
$120.23
Median
$120.23
Typical High
$120.23
Select Health
Setting
Professional
Modifier
Global
Typical Low
$117.49
Median
$120.23
Typical High
$154.88
U of Utah Health Plan
Setting
Professional
Modifier
Global
Typical Low
$83.18
Median
$169.82
Typical High
$269.15
United
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$125.89

Where Utah 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.

Utah $126 · 20th 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.