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Wyoming rates for HCPCS Q4124

OASIS ultra tri-layer 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
$2.48 / $2.48 / $2.48
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.49 / $2.71 / $2.73
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.75 / $15.00 / $15.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.35 / $2.35 / $2.35
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.49 / $3.52 / $3.52
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.49 / $2.49 / $2.49