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Pennsylvania rates for HCPCS Q4157

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

Facilitymedian $178 · 10th–90th $148$4680%50%10th90th$178Professionalmedian $174 · 10th–90th $145$1780%50%10th90th$174$1.0$10.0$100.0$1.0K$10.0K

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
$177.83 / $177.83 / $177.83
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$165.96 / $173.78 / $177.83
Capital Blue Cross
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$147.91 / $173.78 / $5,011.87
Capital Blue Cross
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$173.78 / $173.78 / $173.78
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$125.89 / $446.68 / $478.63
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $125.89 / $125.89
Emblem Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$151.36 / $177.83 / $263.03
Geisinger
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$120.23 / $151.36 / $208.93
Martin's Point
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$177.83 / $177.83 / $177.83
Martin's Point
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$165.96 / $173.78 / $177.83
Oscar Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.60 / $229.09 / $245.47
UPMC Health Plan
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$8.32 / $10.00 / $123.03
UPMC Health Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$6.76 / $8.91 / $123.03
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$154.88 / $154.88 / $154.88
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $125.89 / $194.98