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Montana rates for HCPCS A4802

Protamine sulfate, for hemodialysis, per 50 mg

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.02 / $12.88 / $15.14
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.25 / $5.89 / $6.17
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.25 / $13.49 / $13.49
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.75 / $5.75 / $5.75
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.75 / $5.75 / $5.75
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.47 / $12.88 / $17.38
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.01 / $8.32 / $79.43
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.78 / $2.19 / $3.63