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Michigan 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
$1.70 / $1.70 / $1.70
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.66 / $1.62 / $1.70
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.13 / $1.88 / $2.13
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.38 / $6.72 / $12.25
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.12 / $2.23 / $3.01
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.24 / $1.24 / $1.45
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.52 / $1.52 / $1.52
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.72 / $1.34 / $1.34
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.30 / $1.34 / $1.86
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.62 / $1.70 / $2.06
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.60 / $1.69 / $2.27
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.24 / $0.30 / $1.90
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.74 / $1.03 / $1.54