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Delaware 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
$131.83 / $138.04 / $562.34
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$138.04 / $138.04 / $223.87
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$138.04 / $138.04 / $138.04
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$138.04 / $138.04 / $138.04
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$616.60 / $616.60 / $12,302.69
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.89 / $223.87 / $239.88