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Colorado 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
$167.65 / $167.65 / $167.65
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$144.60 / $167.65 / $178.13
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$142.50 / $142.50 / $142.50
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$161.37 / $167.65 / $184.41
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 / $178.13
Denver HMP
Facility/Professional
Facility
Modifier
Low / Median / High Price
$167.65 / $201.18 / $258.18
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$155.00 / $155.00 / $329.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$202.90 / $202.90 / $202.90