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Indiana 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 / $660.69 / $660.69
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$660.69 / $660.69 / $691.83
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$141.25 / $380.19 / $512.86
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$562.34 / $660.69 / $1,023.29
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$660.69 / $977.24 / $1,318.26
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 / $707.95
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,698.24 / $1,698.24 / $1,698.24
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.89 / $1,023.29 / $1,659.59