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New Hampshire rates for HCPCS Q4157

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

Facilitymedian $178 · 10th–90th $132–$2510%20%10th90th$178Professionalmedian $178 · 10th–90th $126–$1910%50%10th90th$178$100.0$200.0$500.0$1.0K

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
Facility
Modifier
Typical Low / Median / Typical High
$131.83 / $177.83 / $213.80
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$165.96 / $177.83 / $213.80
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $125.89 / $125.89
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$144.54 / $251.19 / $338.84
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 / $288.40
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $173.78 / $177.83
Well Sense
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$117.49 / $144.54 / $162.18