| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $15.00 | $15.00 | $15.00 | |
BCBS
| Professional | $12.00 | $12.00 | $12.00 | |
Cigna
| Professional | $1.68 | $1.68 | $1.68 | |
Molina
| Professional | $17.00 | $21.25 | $50.00 |
Topical Anesthetic For Dialysis Per Gram (Special Coverage Instructions Apply. See Mcm: 4270)
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $15.00 | $15.00 | $15.00 | |
BCBS
| Professional | $12.00 | $12.00 | $12.00 | |
Cigna
| Professional | $1.68 | $1.68 | $1.68 | |
Molina
| Professional | $17.00 | $21.25 | $50.00 |