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Illinois rates for HCPCS A4802

Protamine Sulfate For Hemodialysis Per 50 Mg (Special Coverage Instructions Apply. See Mcm: 4270)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.95 / $19.34 / $26.21
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.78 / $12.78 / $13.58
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$17.46 / $17.46 / $17.46
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$13.58 / $85.00 / $85.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.58 / $13.58 / $13.58
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.38 / $5.54 / $6.94
Hally Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $100.00 / $100.00
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $30.00 / $2,500.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.44 / $2.23 / $3.63