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Louisiana 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
$15.98 / $16.78 / $22.37
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.94 / $13.26 / $15.98
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.31 / $2.64 / $2.71
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$13.58 / $13.58 / $85.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.58 / $13.58 / $13.58
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.44 / $1.90 / $3.30