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Wyoming rates for HCPCS Q4133

Grafix PRIME, GrafixPL PRIME, Stravix and StravixPL, per sq cm (add-on, list separately in addition to primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$136.18 / $136.18 / $136.18
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$138.74 / $151.22 / $152.61
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$240.24 / $282.63 / $282.63
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$240.24 / $282.63 / $282.63
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$130.88 / $130.88 / $130.88
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$138.74 / $196.33 / $196.33
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$138.74 / $138.74 / $138.74