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Georgia 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
$660.69 / $2,754.23 / $10,715.19
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$660.69 / $660.69 / $794.33
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$107.15 / $323.59 / $1,584.89
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$616.60 / $616.60 / $660.69
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$660.69 / $660.69 / $831.76
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$128.82 / $128.82 / $257.04
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,096.48 / $1,995.26 / $2,818.38
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.89 / $1,023.29 / $1,659.59