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Utah 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 / $12.88
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.02 / $12.88 / $13.49
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.49 / $13.49 / $13.49
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.50 / $10.47 / $44.67
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.63 / $3.63 / $3.63
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.08 / $7.08 / $12.88
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.88 / $3.16 / $3.55
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.32 / $2.19 / $3.63