go back

Oregon rates for HCPCS A4652

Microcapillary Tube Sealant (Special Coverage Instructions Apply. See Mcm: 4270)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.12 / $0.12 / $0.12
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$170.00 / $170.00 / $178.00
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.12 / $0.12 / $0.22
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$79,999.20 / $79,999.20 / $79,999.20
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.12 / $0.12 / $0.26
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,250,000.00 / $2,250,000.00 / $2,400,000.00