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Texas 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 / $662.69 / $675.81
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$656.12 / $656.12 / $721.74
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,456.92 / $5,821.21 / $8,577.84
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$100.98 / $100.98 / $100.98
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$80.00 / $121.37 / $121.37
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$618.98 / $656.12 / $656.12
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$656.12 / $656.12 / $656.12
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,417.80 / $2,502.00 / $2,915.49
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,838.00 / $5,838.00 / $5,838.00
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$656.12 / $1,090.07 / $1,390.97
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$656.12 / $656.12 / $820.15
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$148.10 / $420.73 / $1,014.17
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$656.12 / $656.12 / $1,390.97
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$656.12 / $656.12 / $656.12
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$656.12 / $656.12 / $664.65
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$254.99 / $656.12 / $885.76