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Vermont rates for HCPCS Q4157

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

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$165.96 / $173.78 / $177.83
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$177.83 / $177.83 / $177.83
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.89 / $194.98 / $295.12