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Wyoming rates for HCPCS Q4180

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,090.07 / $1,090.07 / $1,090.07
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$656.12 / $715.18 / $721.74
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,417.80 / $1,668.00 / $1,668.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$618.98 / $618.98 / $618.98
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$656.12 / $928.48 / $928.48
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$656.12 / $656.12 / $656.12