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Utah rates for HCPCS A4402

Lubricant, per oz

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.00 / $1.00 / $9.77
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.35 / $1.35 / $1.35
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.12 / $1.12 / $1.51
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.15 / $1.62 / $2.57
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.26 / $1.58 / $2.19
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.95 / $2.24 / $2.29
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.62 / $2.29 / $2.40
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.76 / $0.85 / $0.89
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.74 / $0.95 / $1.35