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Wyoming rates for HCPCS Q4197

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$71.04 / $71.04 / $71.04
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$70.70 / $77.06 / $77.77
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$255.00 / $300.00 / $300.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$66.69 / $66.69 / $66.69
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$70.70 / $100.04 / $100.04
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$70.70 / $70.70 / $70.70