go back

Arkansas rates for HCPCS A4402

Lubricant Per Ounce (Special Coverage Instructions Apply. See Mcm: 2130)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.80 / $1.80 / $1.80
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.62 / $1.80 / $1.80
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$219,999.78 / $539,999.46 / $949,999.05
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.92 / $2.54 / $2.83
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.90 / $1.90 / $2.23
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.23 / $2.23 / $2.23
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.72 / $1.34 / $1.34
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.72 / $1.34 / $1.53
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.63 / $1.01 / $1.34