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New Hampshire rates for HCPCS A4402

Lubricant, per oz

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.00 / $1.00 / $1.20
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.83 / $0.97 / $1.34
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.11 / $1.11 / $1.20
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 / $1.53
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.55 / $1.55 / $4.78
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.63 / $0.95 / $1.51
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.28 / $1.41 / $1.79