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Pennsylvania 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
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.36 / $2.45 / $2.45
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$64.00 / $64.00 / $64.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.88 / $4.88 / $4.88
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.12 / $0.12 / $0.15
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$64.00 / $64.00 / $64.00
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.88 / $4.88 / $4.88