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Pennsylvania rates for HCPCS Q4133

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

Facilitymedian $407 · 10th–90th $138$7,7620%10%20%10th90th$407Professionalmedian $141 · 10th–90th $135$2630%50%10th90th$141$1.0$10.0$100.0$1.0K$10.0K$100.0K

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 / $407.38 / $5,888.44
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$138.04 / $141.25 / $407.38
AmeriHealth
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$131.83 / $22,387.21 / $165,958.69
Capital Blue Cross
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$177.83 / $208.93 / $5,011.87
Capital Blue Cross
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$208.93 / $208.93 / $208.93
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$125.89 / $446.68 / $478.63
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $125.89 / $125.89
Emblem Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$144.54 / $239.88 / $239.88
Geisinger
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$123.03 / $151.36 / $213.80
Highmark BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$245.47 / $263.03 / $346.74
Highmark BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$169.82 / $169.82 / $169.82
Independence Blue Cross
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$128.82 / $22,387.21 / $120,226.44
Martin's Point
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$138.04 / $141.25 / $407.38
Martin's Point
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$138.04 / $138.04 / $199.53
Oscar Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.60 / $229.09 / $302.00
UPMC Health Plan
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$134.90 / $154.88 / $162.18
UPMC Health Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$134.90 / $162.18 / $190.55
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$154.88 / $154.88 / $154.88
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $125.89 / $204.17