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Illinois 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
$232.46 / $656.12 / $1,751.40
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$656.12 / $656.12 / $688.93
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$494.39 / $782.26 / $3,527.39
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,166.20 / $1,166.20 / $1,166.20
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$656.12 / $656.12 / $656.12
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$656.12 / $656.12 / $866.58
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$557.70 / $754.54 / $1,246.63
Hally Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $100.00 / $100.00
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$852.96 / $852.96 / $852.96
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $40.00 / $1,514.31
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$656.12 / $656.12 / $719.33