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North Dakota 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
$1.63 / $1.63 / $1.63
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.66 / $1.42 / $1.63
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.08 / $2.47 / $2.49
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.63 / $2.65 / $3.33
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.09 / $1.63 / $80.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.87 / $1.04 / $1.81
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.63 / $0.95 / $1.78