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Kentucky 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 / $177.83
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$109.65 / $165.96 / $177.83
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$177.83 / $338.84 / $338.84
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$177.83 / $177.83 / $933.25
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$44.67 / $44.67 / $158.49
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.89 / $162.18 / $204.17