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Vermont 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
Professional
Modifier
Low / Median / High Price
$138.74 / $138.74 / $258.06
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$130.88 / $154.38 / $257.29
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$138.74 / $138.74 / $257.29
MVP Health Care
Facility/Professional
Facility
Modifier
Low / Median / High Price
$130.88 / $154.38 / $257.29
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$138.74 / $138.74 / $257.29
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$138.74 / $138.74 / $416.22