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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
$656.12 / $656.12 / $656.12
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$656.12 / $656.12 / $682.37
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,417.80 / $1,417.80 / $2,915.49
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$656.12 / $656.12 / $5,838.00
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$704.02 / $805.72 / $1,479.55
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 / $656.12
Fallon Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$656.12 / $985.82 / $8,090.00
Fallon Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$656.12 / $656.12 / $656.12
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$656.12 / $656.12 / $656.12
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,417.80 / $1,417.80 / $2,915.49
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$656.12 / $656.12 / $5,838.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$656.12 / $656.12 / $1,266.31