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Montana rates for HCPCS Q4157

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

Facilitymedian $204 · 10th–90th $166–$3020%20%10th90th$204Professionalmedian $170 · 10th–90th $126–$1780%50%10th90th$170$100.0$200.0

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

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$165.96 / $173.78 / $177.83
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$144.54 / $144.54 / $204.17
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $125.89 / $181.97
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$165.96 / $204.17 / $302.00
Providence
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$79.43 / $85.11 / $239.88
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $125.89 / $125.89