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Maine 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 / $1.28 / $1.28
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.11 / $1.20 / $1.20
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.12 / $1.34 / $1.67
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.13 / $1.13 / $1.53
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.55 / $1.55 / $1.55
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.68 / $1.28 / $1.70
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.74 / $1.12 / $2.57