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Virginia 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
$1.31 / $1.38 / $1.38
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.62 / $1.38 / $1.58
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.11 / $1.11 / $1.47
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.31 / $1.31 / $1.33
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
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.46 / $1.95 / $2.54
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.61 / $1.43 / $2.48
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.00 / $2.93 / $3.71
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.47 / $1.75 / $2.97
Sentara
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.93 / $1.75 / $2.94
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.87 / $1.10 / $1.46