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Montana rates for HCPCS A9575

Injection Gadoterate Meglumine 0.1 Ml

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$168.43 / $217.60 / $514.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.11 / $0.11 / $14.20
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.56 / $77,999.99 / $94,999.99
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.16 / $0.16 / $0.16
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.13 / $0.13 / $0.56
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.11 / $0.11 / $0.13
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.13 / $0.13 / $0.56
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.13 / $0.13 / $0.14
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.11 / $0.11 / $0.11