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New York 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 / $0.97 / $2.11
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.60 / $0.97 / $2.11
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.11 / $1.46 / $2.92
CDPHP
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.73 / $1.86 / $1.86
CDPHP
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.86 / $1.86 / $1.86
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
Facility
Modifier
Low / Median / High Price
$2.23 / $5.01 / $332.00
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.28 / $1.67 / $3.95
Excellus BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.43 / $0.43 / $0.43
Excellus BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.43 / $1.62 / $1.62
Fidelis
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.28 / $0.28 / $0.28
Highmark BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.43 / $1.43 / $1.43
MVP Health Care
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.72 / $1.34 / $555.00
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.13 / $1.13 / $3.28
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.74 / $1.12 / $1.93
Univera
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.60 / $1.62 / $1.62
Univera
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.43 / $1.62 / $1.62