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Massachusetts rates for HCPCS Q4157

Revitalon Per Square Centimeter

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$178.13 / $178.13 / $178.13
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$167.65 / $178.13 / $178.13
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$209.56 / $209.56 / $419.12
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$202.90 / $202.90 / $796.33
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
Fallon Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$83.43 / $4,618.00 / $9,239.00
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$178.13 / $178.13 / $178.13
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$209.56 / $209.56 / $419.12
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$202.90 / $202.90 / $796.33
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$178.13 / $202.90 / $335.60