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South Dakota 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
$12.78 / $15.98 / $15.98
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.75 / $4.69 / $13.58
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.05 / $15.98 / $28.76
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.80 / $2.17 / $55.93
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.05 / $5.43 / $7.67
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.55 / $5.43 / $6.99
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.73 / $6.73 / $6.73
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.33 / $1.97 / $3.61