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Maryland 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
$13.58 / $13.58 / $13.58
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.78 / $13.26 / $13.58
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$85.00 / $85.00 / $85.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.58 / $13.58 / $13.58
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.08 / $4.01 / $6.05
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.99 / $2.58 / $4.23