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Wyoming rates for HCPCS Q4110

PriMatrix, 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
$64.57 / $64.57 / $91.20
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$81.28 / $95.50 / $95.50
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$61.66 / $61.66 / $61.66
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$66.07 / $66.07 / $93.33
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$66.07 / $79.43 / $125.89