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Maine rates for HCPCS Q4158

Kerecis Omega3, per sq cm (add-on, list separately in addition to primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$67.61 / $67.61 / $85.11
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$177.83 / $177.83 / $199.53
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$67.61 / $67.61 / $67.61
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$67.61 / $67.61 / $67.61
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$67.61 / $67.61 / $81.28
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$67.61 / $67.61 / $131.83
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$67.61 / $125.89 / $199.53