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South Dakota 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
Professional
Modifier
Low / Median / High Price
$3.72 / $4.68 / $13.49
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.50 / $15.85 / $26.92
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.82 / $1.95 / $56.23
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.79 / $5.37 / $7.59
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.92 / $6.92 / $6.92
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.76 / $6.76 / $6.76
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.32 / $2.19 / $3.63