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Alaska rates for HCPCS Q4157

Revitalon, per sq cm (add-on, list separately in addition to primary procedure)

Facilitymedian $209 · 10th–90th $158–$3390%10%20%10th90th$209Professionalmedian $178 · 10th–90th $166–$3090%20%10th90th$178$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
Professional
Modifier
Typical Low / Median / Typical High
$165.96 / $173.78 / $208.93
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$144.54 / $144.54 / $144.54
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $125.89 / $125.89
Moda Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$165.96 / $208.93 / $309.03
Moda Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$173.78 / $302.00 / $512.86
Premera BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$295.12 / $295.12 / $457.09
Premera BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$199.53 / $229.09 / $251.19
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$158.49 / $208.93 / $309.03
Providence
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$60.26 / $125.89 / $239.88
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$83.18 / $125.89 / $316.23