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Arizona rates for HCPCS Q4133

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$277.48 / $938.20 / $2,055.60
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$138.74 / $140.13 / $208.11
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$109.97 / $259.80 / $642.49
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$111.69 / $137.46 / $324.76
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$135.41 / $138.74 / $138.74
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$138.74 / $138.74 / $138.74
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$132.77 / $164.77 / $301.72
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$136.18 / $136.18 / $295.51
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$138.74 / $138.74 / $138.74