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Wyoming rates for HCPCS Q4250

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,901.66 / $2,901.66 / $2,901.66
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,979.56 / $3,247.71 / $3,277.51
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,422.50 / $2,850.00 / $2,850.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,810.90 / $2,810.90 / $2,810.90
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,979.55 / $4,216.35 / $4,216.35
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,979.56 / $2,979.56 / $2,979.56