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Wyoming rates for HCPCS Q4126

MemoDerm, DermaSpan, TranZgraft or InteguPly, per sq cm (add-on, list separately in addition to primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$59.81 / $59.81 / $59.81
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$62.41 / $68.03 / $68.66
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$82.88 / $97.50 / $97.50
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$58.88 / $58.88 / $58.88
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$62.41 / $88.32 / $88.32
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$62.41 / $62.41 / $62.41