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Ohio 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
$1.42 / $1.42 / $2.25
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.68 / $1.42 / $1.77
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.52 / $1.75 / $2.13
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.11 / $1.20 / $2.89
Aultcare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.23 / $2.23 / $2.23
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.62 / $2.23 / $3.01
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.33 / $2.23 / $4.76
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.72 / $1.34 / $2.61
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.13 / $1.13 / $1.53
Medical Mutual of Ohio
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.72 / $1.34 / $1.34
Medical Mutual of Ohio
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.00 / $1.34 / $1.38
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.78 / $0.98 / $1.41
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.73 / $1.01 / $1.43