| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $0.12 | $0.12 | $0.12 | |
Aetna
| Professional | $0.12 | $0.12 | $0.15 | |
Kaiser Permanente
| Professional | $8.00 | $8.00 | $8.00 |
Microcapillary Tube Sealant (Special Coverage Instructions Apply. See Mcm: 4270)
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $0.12 | $0.12 | $0.12 | |
Aetna
| Professional | $0.12 | $0.12 | $0.15 | |
Kaiser Permanente
| Professional | $8.00 | $8.00 | $8.00 |