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Wisconsin rates for HCPCS A4802

Protamine sulfate, for hemodialysis, per 50 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12.02 / $28.18 / $28.18
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.02 / $12.88 / $14.13
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.39 / $13.18 / $13.18
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8.91 / $12.02 / $16.98
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.68 / $7.08 / $13.49
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.50 / $13.18 / $15.85
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.72 / $13.18 / $17.38
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.82 / $2.19 / $56.23
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $54.95 / $70.79
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.98 / $6.61 / $11.48
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$13.49 / $85.11 / $100.00
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.49 / $13.49 / $72.44
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.38 / $2.04 / $3.80