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Texas rates for HCPCS A4802

Protamine sulfate, for hemodialysis, per 50 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12.88 / $12.88 / $13.18
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.02 / $12.88 / $14.45
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10.00 / $13.49 / $85.11
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.49 / $13.49 / $13.49
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $100.00 / $100.00
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$72.44 / $72.44 / $72.44
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.27 / $13.18 / $19.05
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.02 / $12.88 / $12.88
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.20 / $30.20 / $30.20
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.60 / $0.60 / $0.60
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.37 / $13.18 / $19.05
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.14 / $15.14 / $15.14
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.78 / $2.14 / $3.80
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.18 / $13.18 / $16.60