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Utah rates for HCPCS C9354

Acellular pericardial tissue matrix of nonhuman origin (Veritas), per sq cm

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$18.20 / $18.20 / $18.20
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$18.20 / $18.20 / $19.05
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$19.50 / $19.50 / $19.50
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.50 / $19.50 / $19.50
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.44 / $25.70 / $75.86
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.22 / $22.91 / $24.55
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$22.91 / $22.91 / $22.91