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Wyoming rates for HCPCS Q4204

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$128.82 / $128.82 / $128.82
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,715.35 / $3,715.35 / $4,265.80
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,884.03 / $3,388.44 / $3,388.44
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,467.37 / $3,467.37 / $3,467.37
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,715.35 / $3,715.35 / $5,248.07
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.89 / $2,818.38 / $2,951.21