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Minnesota 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
$1.42 / $1.42 / $1.42
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.62 / $1.42 / $1.63
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.00 / $2.39 / $3.14
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.78 / $2.16 / $2.23
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.34 / $7.24 / $20.11
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.63 / $2.78 / $3.33
Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.30 / $6.88 / $15.84
Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.63 / $2.63 / $2.80
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.63 / $2.23 / $80.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.63 / $1.08 / $2.47
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.63 / $0.95 / $2.25