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Wyoming rates for HCPCS Q4191

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$730.43 / $730.43 / $730.43
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$655.29 / $714.28 / $720.83
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,487.50 / $1,750.00 / $1,750.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$618.21 / $618.21 / $618.21
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$655.29 / $927.31 / $927.31
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$655.29 / $655.29 / $655.29