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Kansas 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
$165.96 / $165.96 / $165.96
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$165.96 / $173.78 / $208.93
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$169.82 / $177.83 / $177.83
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$177.83 / $177.83 / $177.83
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$165.96 / $208.93 / $467.74
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$204.17 / $204.17 / $794.33
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$173.78 / $204.17 / $204.17
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.89 / $204.17 / $204.17