| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $0.12 | $0.12 | $0.15 | |
BCBS
| Professional | $0.15 | $0.15 | $0.15 | |
Cigna
| Professional | $11.72 | $11.72 | $11.72 | |
Molina
| Professional | $17.00 | $21.25 | $50.00 |
Microcapillary Tube Sealant (Special Coverage Instructions Apply. See Mcm: 4270)
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $0.12 | $0.12 | $0.15 | |
BCBS
| Professional | $0.15 | $0.15 | $0.15 | |
Cigna
| Professional | $11.72 | $11.72 | $11.72 | |
Molina
| Professional | $17.00 | $21.25 | $50.00 |