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Illinois 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
$1.06 / $1.06 / $1.06
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.66 / $1.06 / $1.95
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.45 / $1.45 / $1.45
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.18 / $5.49 / $16.59
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.26 / $1.43 / $1.43
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.72 / $1.34 / $2.35
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.13 / $1.13 / $2.63
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.82 / $2.63 / $5.38
Hally Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $100.00 / $100.00
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.47 / $2.47 / $2.90
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.86 / $2.58 / $2.85
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.79 / $0.95 / $1.67