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Rhode Island 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
$51.94 / $51.94 / $51.94
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.94 / $13.26 / $13.58
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$13.58 / $13.58 / $13.58
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.58 / $13.58 / $13.58
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.02 / $2.29 / $3.96