go back

Texas rates for HCPCS Q4157

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

Facilitymedian $209 · 10th–90th $145$7080%10%20%10th90th$209Professionalmedian $170 · 10th–90th $126$2040%50%10th90th$170$2.0$10.0$50.0$200.0$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
$165.96 / $169.82 / $169.82
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$165.96 / $173.78 / $181.97
Christus
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$79.43 / $120.23 / $125.89
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$144.54 / $309.03 / $851.14
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $125.89 / $125.89
Lucent Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$707.95 / $707.95 / $707.95
Lucent Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$794.33 / $933.25 / $933.25
Moda Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$154.88 / $208.93 / $302.00
Moda Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$162.18 / $173.78 / $223.87
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$30.20 / $30.20 / $33.11
Oscar Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$204.17 / $245.47 / $302.00
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$165.96 / $208.93 / $363.08
Providence
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $125.89 / $125.89
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$102.33 / $204.17 / $331.13
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $125.89 / $204.17
Wellpoint
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$109.65 / $125.89 / $125.89