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Pennsylvania rates for HCPCS Q4158

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$66.98 / $67.27 / $175.09
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$67.27 / $67.27 / $67.95
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$57.43 / $67.27 / $8,639.91
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$67.27 / $67.27 / $67.27
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$67.27 / $67.27 / $67.27
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$67.27 / $67.27 / $69.81
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$66.64 / $69.81 / $116.36
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,506.75 / $1,506.75 / $1,506.75
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$66.98 / $67.27 / $175.09
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$67.27 / $67.27 / $67.95
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$467.00 / $467.00 / $467.00
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$63.47 / $67.27 / $67.27
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$67.27 / $67.27 / $76.16
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$29.92 / $29.92 / $29.92
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$29.92 / $29.92 / $30.52
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$67.27 / $67.27 / $123.10