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North Carolina 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
$132.79 / $1,995.00 / $4,491.20
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$132.79 / $138.74 / $145.68
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$109.40 / $117.06 / $276.10
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$89.46 / $96.38 / $106.02
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$130.88 / $138.74 / $138.74
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$138.74 / $138.74 / $282.63
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$132.79 / $167.68 / $310.89
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$167.68 / $167.68 / $173.94
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$191.50 / $191.50 / $301.60
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$138.74 / $138.74 / $180.36
Wellcare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$240.24 / $403.13 / $612.61
Wellcare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,448.75 / $1,448.75 / $1,448.75