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Utah rates for HCPCS A2004

XCelliStem, 1 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12.02 / $12.02 / $12.02
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.02 / $12.02 / $12.88
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$13.18 / $13.18 / $13.18
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.18 / $13.18 / $13.18
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.20 / $44.67 / $60.26
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.00 / $14.13 / $14.13
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.88 / $12.88 / $12.88