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Wyoming rates for HCPCS Q4259

Celera Dual Layer or Celera Dual Membrane, per sq cm (add-on, list separately in addition to primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$941.46 / $941.46 / $941.46
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$713.50 / $777.72 / $784.85
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,351.50 / $1,590.00 / $1,590.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$673.11 / $673.11 / $673.11
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$713.50 / $1,009.67 / $1,009.67
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$713.50 / $713.50 / $713.50