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Wyoming rates for HCPCS Q4108

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$128.82 / $128.82 / $128.82
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.02 / $38.02 / $52.48
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.10 / $74.13 / $74.13
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$36.31 / $36.31 / $36.31
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.90 / $46.77 / $54.95
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.12 / $61.66 / $125.89