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Michigan 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
$676.08 / $676.08 / $676.08
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$660.69 / $660.69 / $724.44
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$660.69 / $660.69 / $1,122.02
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$213.80 / $1,778.28 / $4,786.30
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$138.04 / $676.08 / $2,187.76
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$660.69 / $660.69 / $1,047.13
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,659.59 / $1,659.59 / $1,698.24
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.89 / $1,023.29 / $1,659.59