go back

Michigan rates for HCPCS A4802

Protamine sulfate, for hemodialysis, per 50 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12.78 / $12.78 / $39.86
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.78 / $12.94 / $13.58
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.90 / $2.41 / $4.94
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.86 / $0.95 / $1.12
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.47 / $13.58 / $13.58
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11.31 / $15.98 / $35.56
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.78 / $14.12 / $16.94
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $30.00 / $75.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.33 / $2.14 / $3.96