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Ohio 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 / $767.67
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$656.12 / $656.12 / $675.81
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$656.12 / $749.28 / $1,273.92
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$656.12 / $656.12 / $1,115.40
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$656.12 / $656.12 / $885.76
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$618.98 / $618.98 / $656.12
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$656.12 / $656.12 / $928.48
Medical Mutual of Ohio
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,417.80 / $1,417.80 / $1,417.80
Medical Mutual of Ohio
Facility/Professional
Professional
Modifier
Low / Median / High Price
$656.12 / $656.12 / $928.48
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$721.73 / $1,133.15 / $1,417.09
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$656.12 / $656.12 / $843.77