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Utah 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
$0.61 / $0.61 / $0.61
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.61 / $0.70 / $6.45
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 / $1.34 / $2.63
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.33 / $1.63 / $2.13
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.25 / $1.56 / $2.34
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.74 / $0.95 / $1.67