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Tennessee 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
$138.74 / $5,728.80 / $7,267.50
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$138.74 / $138.74 / $152.61
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$136.18 / $141.32 / $282.63
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$138.74 / $138.74 / $138.74
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$138.74 / $138.74 / $138.74
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$240.24 / $612.61 / $612.61
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,448.75 / $1,448.75 / $1,448.75
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$138.74 / $138.74 / $138.74