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California 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
$0.60 / $0.66 / $6.45
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.60 / $0.70 / $1.95
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.76 / $2.13 / $2.13
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.86 / $1.04 / $2.75
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.11 / $1.12 / $2.06
Blue Shield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.36 / $3.06 / $4.73
Blue Shield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.21 / $4.79 / $8.39
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.12 / $1.34 / $4.44
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.13 / $1.13 / $1.44
Contra Costa Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.78 / $2.23 / $3.01
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.34 / $1.56 / $3.46
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.27 / $80.00 / $80.00
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.09 / $23.63 / $23.63
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.61 / $1.98 / $2.27
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.13 / $1.34 / $2.12
Sutter Health Plus
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.22 / $4.22 / $4.22
The Alliance
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.03 / $1.78 / $1.78
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.87 / $0.95 / $2.23