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Indiana rates for HCPCS Q4157

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

Facilitymedian $288 · 10th–90th $135–$5130%10%10th90th$288Professionalmedian $166 · 10th–90th $145–$1780%50%10th90th$166$100.0$200.0$500.0$1.0K

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
Facility
Modifier
Typical Low / Median / Typical High
$165.96 / $165.96 / $165.96
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$165.96 / $169.82 / $177.83
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$134.90 / $316.23 / $512.86
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$109.65 / $165.96 / $295.12
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$169.82 / $346.74 / $346.74
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $125.89 / $131.83
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$102.33 / $102.33 / $102.33
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $125.89 / $204.17