go back

Missouri 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
$1.13 / $1.70 / $2.14
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.92 / $1.13 / $2.37
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.00 / $32.00 / $32.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.02 / $1.11 / $1.73
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 / $1.44
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.00 / $1.93 / $80.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.79 / $1.07 / $1.78
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.74 / $1.07 / $1.53