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Michigan rates for HCPCS Q4133

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

Facilitymedian $741 · 10th–90th $102–$1,9950%20%10th90th$741Professionalmedian $138 · 10th–90th $126–$2510%20%40%10th90th$138$20.0$50.0$100.0$200.0$500.0$1.0K$2.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$141.25 / $933.25 / $1,995.26
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$138.04 / $141.25 / $251.19
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$15.14 / $89.13 / $89.13
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$15.14 / $89.13 / $93.33
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $144.54 / $144.54
Health Alliance Plan
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$147.91 / $302.00 / $933.25
Health Alliance Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$131.83 / $147.91 / $389.05
Priority Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $144.54 / $144.54
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$102.33 / $102.33 / $281.84
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $125.89 / $147.91