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Wyoming rates for HCPCS Q4253

Zenith Amniotic Membrane, 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
$75.86 / $75.86 / $107.15
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$977.24 / $1,148.15 / $1,148.15
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$70.79 / $70.79 / $70.79
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$75.86 / $75.86 / $107.15
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$70.79 / $125.89 / $954.99