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Arizona rates for HCPCS A4736

Topical Anesthetic For Dialysis Per Gram (Special Coverage Instructions Apply. See Mcm: 4270)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.00 / $15.00 / $15.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.68 / $1.68 / $1.68
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15.00 / $15.00 / $24.15
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$18.00 / $18.00 / $18.00