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Montana rates for HCPCS Q4180

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

Facilitymedian $437 · 10th–90th $182–$1,8620%20%10th90th$437Professionalmedian $661 · 10th–90th $166–$8130%50%10th90th$661$100.0$500.0$2.0K$10.0K$50.0K

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
Professional
Modifier
Typical Low / Median / Typical High
$660.69 / $660.69 / $794.33
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$64,565.42 / $77,624.71 / $95,499.26
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$144.54 / $1,174.90 / $1,174.90
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $181.97 / $1,174.90
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$177.83 / $398.11 / $1,202.26
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$177.83 / $398.11 / $1,202.26
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$204.17 / $676.08 / $1,174.90
Providence
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$79.43 / $125.89 / $1,819.70
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $125.89 / $125.89