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Virginia 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
$178.13 / $178.13 / $178.13
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$167.65 / $178.13 / $178.13
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$167.65 / $167.65 / $224.71
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$178.13 / $178.13 / $178.13
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
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$162.32 / $182.61 / $182.61
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$178.13 / $209.56 / $271.29
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$199.08 / $209.56 / $209.56
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$173.93 / $199.08 / $260.89
Sentara
Facility/Professional
Professional
Modifier
Low / Median / High Price
$173.93 / $199.08 / $260.89
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$202.90 / $202.90 / $213.05