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Arizona rates for HCPCS Q4180

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$724.44 / $724.44 / $724.44
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$660.69 / $660.69 / $794.33
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$891.25 / $1,479.11 / $3,630.78
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,047.13 / $1,479.11 / $2,398.83
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$660.69 / $660.69 / $660.69
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$660.69 / $660.69 / $660.69
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$954.99 / $1,202.26 / $2,454.71
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,096.48 / $1,096.48 / $1,659.59
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,659.59 / $1,698.24 / $1,698.24
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.89 / $1,023.29 / $1,659.59