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Mississippi 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
$688.93 / $688.93 / $787.35
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$656.12 / $688.93 / $787.35
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$136.87 / $136.87 / $136.87
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
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $30.00 / $30.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$623.30 / $656.12 / $852.96