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Pennsylvania 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 / $1.51
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.66 / $1.13 / $1.51
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,000.00 / $8,639.91 / $79,506.39
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.48 / $1.95 / $1.95
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.34 / $1.34 / $2.61
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 / $2.06 / $3.02
Highmark BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.46 / $1.46 / $1.46
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.95 / $0.95 / $1.51
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.60 / $1.08 / $1.51
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.40 / $2.80 / $3.80
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.34 / $1.34 / $2.61
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.13 / $1.13 / $2.63
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.45 / $1.85 / $1.85
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.45 / $1.85 / $2.12
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.76 / $0.97 / $1.62