go back

Washington, DC 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
$177.83 / $177.83 / $177.83
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$165.96 / $177.83 / $177.83
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$177.83 / $177.83 / $177.83
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$177.83 / $177.83 / $177.83
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$177.83 / $177.83 / $177.83
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$138.04 / $173.78 / $181.97
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$204.17 / $204.17 / $204.17
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.89 / $177.83 / $204.17