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Oregon 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
$31.96 / $31.96 / $31.96
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.78 / $13.26 / $13.58
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
$6.07 / $7.10 / $9.36
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.11 / $13.26 / $17.57
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.02 / $7.02 / $7.02
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.50 / $6.61 / $6.70
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.10 / $13.26 / $20.29
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.92 / $9.03 / $2,400,000.00
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.71 / $7.43 / $9.25
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.44 / $2.17 / $3.58