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Alabama rates for HCPCS Q4157

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$178.13 / $178.13 / $178.13
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$169.74 / $178.13 / $178.13
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$178.13 / $178.13 / $178.13
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$178.13 / $178.13 / $281.61
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$176.52 / $202.90 / $202.90