go back

Montana rates for HCPCS A4802

Protamine sulfate, for hemodialysis, per 50 mg

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.78 / $13.26 / $13.58
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.26 / $5.86 / $6.11
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.26 / $13.58 / $13.58
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.48 / $6.12 / $15.98
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.26 / $8.25 / $2,250,000.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.77 / $2.17 / $2.17