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Virginia rates for HCPCS Q4157

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

Facilitymedian $178 · 10th–90th $174–$2880%20%40%10th90th$178Professionalmedian $174 · 10th–90th $145–$2090%20%40%10th90th$174$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
$177.83 / $177.83 / $177.83
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$165.96 / $177.83 / $208.93
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$165.96 / $165.96 / $316.23
CareFirst
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$177.83 / $177.83 / $177.83
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$177.83 / $251.19 / $316.23
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $125.89 / $125.89
Kaiser Permanente
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$120.23 / $162.18 / $239.88
Medcost
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$173.78 / $204.17 / $281.84
Medcost
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$109.65 / $208.93 / $208.93
Sentara
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$165.96 / $199.53 / $257.04
Sentara
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$165.96 / $199.53 / $257.04
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$181.97 / $331.13 / $436.52
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $125.89 / $204.17