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Maine rates for HCPCS Q4157

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

Facilitymedian $145 · 10th–90th $145–$3630%50%90th$145Professionalmedian $178 · 10th–90th $138–$2090%20%40%10th90th$178$100.0$200.0$500.0

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Small sample — interpret with caution. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$165.96 / $173.78 / $208.93
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $125.89 / $199.53
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$144.54 / $144.54 / $363.08
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $125.89 / $125.89
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$177.83 / $177.83 / $181.97
Martin's Point
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$165.96 / $173.78 / $208.93
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $177.83 / $177.83