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Washington, DC 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
$1.31 / $1.31 / $1.31
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.66 / $1.31 / $1.31
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.31 / $1.31 / $1.33
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.13 / $1.13 / $1.13
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.86 / $3.86 / $3.86
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.65 / $0.97 / $1.38