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South Carolina rates for HCPCS A4802

Protamine Sulfate For Hemodialysis Per 50 Mg (Special Coverage Instructions Apply. See Mcm: 4270)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9.99 / $13.10 / $13.58
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$13.58 / $85.00 / $85.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.58 / $13.58 / $13.58
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.34 / $5.20 / $16.38
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.80 / $3.80 / $3.80
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $30.00 / $30.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.36 / $1.97 / $2.71