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Michigan rates for HCPCS A4652

Microcapillary tube sealant

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 / $0.19
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.34 / $1.34 / $1.34
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.27 / $1.41 / $1.68
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.60 / $39.60 / $39.60
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.12 / $0.12 / $0.12
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.12 / $0.12 / $0.15
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $30.00 / $75.00