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Washington rates for HCPCS A4802

Protamine sulfate, for hemodialysis, per 50 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$13.58 / $13.58 / $30.83
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.78 / $13.26 / $15.91
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$85.00 / $100.00 / $100.00
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.73 / $55.93 / $71.91
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.58 / $13.58 / $13.58
Kaiser Permanente
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.41 / $5.66 / $8.57
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.12 / $5.45 / $8.66
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $50.00 / $75.00
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.50 / $6.61 / $6.70
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.26 / $13.58 / $17.42
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.77 / $7.04 / $10.11
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.44 / $2.17 / $3.61
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.32 / $13.32 / $13.32