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Minnesota 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 / $0.15
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.00 / $1.00 / $1.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.64 / $1.64 / $1.64
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.12 / $0.12 / $0.20
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.77 / $6.77 / $6.77