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Georgia 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
$133.27 / $4,659.35 / $9,547.20
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$138.74 / $138.74 / $201.17
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$138.74 / $138.74 / $141.51
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$138.74 / $138.74 / $271.93
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$130.88 / $130.88 / $138.74
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$138.74 / $138.74 / $176.70
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$138.75 / $138.75 / $330.00
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$192.97 / $235.86 / $256.67
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$138.74 / $138.74 / $212.27