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Tennessee 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
$173.93 / $173.93 / $304.38
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$167.65 / $173.93 / $178.13
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$188.60 / $205.57 / $216.89
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$178.13 / $178.13 / $178.13
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$178.13 / $178.13 / $178.13
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$209.56 / $419.12 / $785.85
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$796.33 / $796.33 / $943.02
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$192.76 / $202.90 / $202.90