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California rates for HCPCS A4652

Microcapillary Tube Sealant (Special Coverage Instructions Apply. See Mcm: 4270)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.12 / $0.12 / $0.12
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.12 / $0.12 / $0.18
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$26.11 / $26.11 / $118.16
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$25.50 / $30.00 / $30.00
Blue Shield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.00 / $40.00 / $40.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$64.00 / $64.00 / $64.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.89 / $1.89 / $4.88
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$257.77 / $638.07 / $801.00
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$90.00 / $100.00 / $100.00
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.77 / $6.77 / $6.77
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.00 / $70.00 / $85.00
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.12 / $0.12 / $0.19
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,800,000.00 / $2,400,000.00 / $2,400,000.00