go back

Utah rates for HCPCS A4802

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$13.26 / $13.26 / $13.26
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.78 / $13.26 / $13.58
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.58 / $13.58 / $13.58
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.51 / $10.38 / $45.00
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.64 / $3.64 / $3.64
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.36 / $2.17 / $3.61