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Vermont rates for HCPCS Q4132

Grafix Core and GrafixPL Core, per sq cm (add-on, list separately in addition to primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$106.70 / $106.70 / $397.77
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$42.46 / $42.46 / $100.66
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$70.76 / $106.70 / $106.70
MVP Health Care
Facility/Professional
Facility
Modifier
Low / Median / High Price
$42.46 / $42.46 / $100.66
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$70.76 / $106.70 / $110.73
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$106.70 / $106.70 / $320.10