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Wisconsin 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
$12.78 / $28.50 / $28.50
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.78 / $13.26 / $13.58
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.22 / $11.99 / $13.32
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10.24 / $11.97 / $16.98
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.98 / $6.90 / $13.58
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.49 / $12.78 / $15.98
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.72 / $13.26 / $15.98
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.90 / $2.17 / $55.93
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.00 / $58.40 / $70.00
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.34 / $12.78 / $15.98
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.60 / $6.92 / $11.00
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$65.00 / $85.00 / $100.00
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.58 / $16.94 / $55.93
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.37 / $2.04 / $3.68