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Connecticut 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
$1.22 / $1.22 / $1.22
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.95 / $1.22 / $1.50
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.11 / $1.11 / $1.20
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.72 / $1.34 / $1.34
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.13 / $1.13 / $1.34
ConnectiCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.24 / $1.24 / $1.76
ConnectiCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.24 / $1.33 / $1.90
Health New England
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.43 / $0.43 / $0.43
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.72 / $0.95 / $1.21