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Mississippi 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
$169.82 / $169.82 / $251.19
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$165.96 / $173.78 / $208.93
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$190.55 / $190.55 / $190.55
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$177.83 / $177.83 / $177.83
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$177.83 / $177.83 / $177.83
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.38 / $25.12 / $50.12
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$123.03 / $190.55 / $204.17