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Wyoming rates for HCPCS Q4115

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14.48 / $14.48 / $14.48
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.86 / $14.02 / $14.15
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12.13 / $12.13 / $12.13
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.86 / $18.20 / $18.20
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.86 / $12.86 / $12.86