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Iowa 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
$1.42 / $1.42 / $1.63
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.66 / $1.42 / $1.77
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.72 / $1.34 / $2.45
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.34 / $2.45 / $3.28
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.90 / $2.20 / $3.16
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.52 / $2.64 / $80.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.87 / $1.12 / $3.06
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.35 / $2.45 / $3.22
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.92 / $2.82 / $4.51
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.87 / $1.12 / $2.92
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.00 / $2.00 / $2.00
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.59 / $2.00 / $2.00