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Montana rates for HCPCS A4736

Topical anesthetic, for dialysis, per g

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9.00 / $15.00 / $15.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.68 / $1.68 / $1.68
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15.00 / $15.00 / $23.10
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.68 / $2,250,000.00 / $2,400,000.00