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Missouri rates for HCPCS Q4180

Revita, per sq cm (add-on, list separately in addition to primary procedure)

Facilitymedian $1,122 · 10th–90th $145$1,8200%10%10th90th$1,122Professionalmedian $661 · 10th–90th $110$7940%20%40%10th90th$661$100.0$200.0$500.0$1.0K$2.0K$5.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$660.69 / $676.08 / $1,737.80
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$660.69 / $660.69 / $794.33
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$97.72 / $109.65 / $144.54
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$123.03 / $144.54 / $181.97
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$144.54 / $239.88 / $371.54
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $125.89 / $151.36
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$794.33 / $1,288.25 / $2,570.40
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$977.24 / $1,096.48 / $5,888.44
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$102.33 / $1,380.38 / $1,513.56
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$123.03 / $125.89 / $1,023.29