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Ohio rates for HCPCS A4652

Microcapillary tube sealant

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.00 / $2.40 / $3.98
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.20 / $33.88 / $51.29
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$64.57 / $64.57 / $64.57
Medical Mutual of Ohio
Facility/Professional
Facility
Modifier
Low / Median / High Price
$64.57 / $64.57 / $64.57
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$33.11 / $50.12 / $60.26
SummaCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.12 / $60.26 / $75.86