go back

Wisconsin rates for HCPCS A4652

Microcapillary tube sealant

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.00 / $3.98 / $15.14
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$25.70 / $25.70 / $33.11
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.17 / $1.23 / $1.23
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.12 / $0.12 / $0.19
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.12 / $0.12 / $2.51
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.76 / $6.76 / $6.76
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $54.95 / $70.79
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$64.57 / $64.57 / $64.57
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.17 / $6.76 / $6.76