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New Jersey 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
$0.95 / $0.95 / $1.32
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.66 / $0.95 / $1.77
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.95 / $1.95 / $1.95
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
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.66 / $1.76 / $2.45
Horizon BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.66 / $1.30 / $1.30
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.79 / $0.97 / $1.62