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New Mexico 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
$1.62 / $1.62 / $1.62
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.66 / $1.38 / $6.45
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.15 / $1.55 / $1.85
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.34 / $1.34 / $1.34
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.13 / $1.34 / $1.53
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.27 / $2.85 / $4.27
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.61 / $0.61 / $1.47
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.13 / $1.53 / $2.33
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.87 / $0.95 / $1.43