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Wyoming rates for HCPCS Q4102

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11.70 / $11.70 / $11.70
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.88 / $12.95 / $13.07
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.48 / $13.50 / $13.50
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11.21 / $11.21 / $11.21
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.88 / $16.82 / $16.82
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.88 / $11.88 / $11.88