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Washington 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 / $0.27
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.12 / $0.12 / $0.19
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.45 / $25.50 / $40.00
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $50.00 / $75.00
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$79,999.20 / $79,999.20 / $79,999.20
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$25.50 / $25.50 / $25.50