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Wisconsin 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
$18.23 / $18.23 / $18.23
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$18.23 / $18.23 / $19.38
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.00 / $19.00 / $19.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$19.38 / $19.38 / $19.38
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.38 / $19.38 / $19.38
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$18.23 / $18.23 / $27.36
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$18.23 / $18.47 / $32.83
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$86.64 / $86.64 / $86.64
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.00 / $65.00 / $85.00
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$18.23 / $18.23 / $27.36
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,900.00 / $5,900.00 / $5,900.00
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$65.00 / $85.00 / $100.00
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.38 / $24.17 / $86.64