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Massachusetts 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 / $794.33
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,011.87 / $5,011.87 / $5,011.87
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.89 / $125.89 / $1,659.59
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,584.89 / $1,584.89 / $3,162.28
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
Fallon Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$134.90 / $234.42 / $8,511.38
Fallon Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$181.97 / $181.97 / $213.80
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$660.69 / $660.69 / $660.69
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,011.87 / $5,011.87 / $5,011.87
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.89 / $125.89 / $1,659.59
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,023.29 / $1,698.24 / $2,238.72
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.89 / $660.69 / $1,659.59