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Georgia 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
$1.20 / $1.20 / $1.20
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.97 / $1.29 / $1.87
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.24 / $32.00 / $98.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.05 / $1.58 / $3.59
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.62 / $1.90 / $3.89
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.62 / $1.62 / $1.62
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 / $2.59
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.44 / $1.90 / $3.42
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.63 / $0.93 / $1.56