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Indiana 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
$1.62 / $1.62 / $1.90
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.60 / $1.23 / $1.62
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.13 / $2.13 / $2.13
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.11 / $1.11 / $2.14
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.11 / $1.11 / $1.53
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.56 / $2.23 / $2.85
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.62 / $2.19 / $2.66
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 / $1.34 / $1.95
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.63 / $0.95 / $1.36