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Washington 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
$19.38 / $19.38 / $19.38
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$18.23 / $19.38 / $19.38
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$80.00 / $100.00 / $100.00
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$86.64 / $86.64 / $102.60
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$19.38 / $19.38 / $77.52
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.38 / $19.38 / $19.38
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $30.00 / $30.00
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$79,999.20 / $79,999.20 / $79,999.20
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.00 / $19.00 / $19.00