go back

Maryland rates for HCPCS A4402

Lubricant Per Ounce (Special Coverage Instructions Apply. See Mcm: 2130)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.66 / $1.23 / $1.87
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.31 / $1.31 / $1.33
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 / $1.53
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.37 / $2.00 / $3.12
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.80 / $1.10 / $1.77
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.20 / $1.20 / $1.56