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West 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
$1.23 / $1.23 / $1.23
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.19 / $1.23 / $1.38
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.45 / $2.68 / $3.90
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.33 / $1.56 / $2.27
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.72 / $1.34 / $2.61
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.72 / $1.34 / $10.94
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.82 / $1.12 / $1.81