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Georgia 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
$173.93 / $173.93 / $173.93
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$167.65 / $173.93 / $178.13
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$161.37 / $192.76 / $192.76
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$178.13 / $183.37 / $183.37
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
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$178.13 / $178.13 / $213.76
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$192.97 / $192.97 / $239.19
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$202.90 / $202.90 / $235.18