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Wyoming rates for HCPCS Q4203

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$871.37 / $871.37 / $871.37
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,052.89 / $1,147.65 / $1,158.18
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$848.30 / $998.00 / $998.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$993.29 / $993.29 / $993.29
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,052.89 / $1,489.93 / $1,489.93
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,052.89 / $1,052.89 / $1,052.89