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Minnesota rates for HCPCS A9576

Injection Gadoteridol (Prohance Multipack) Per Ml

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.42 / $1.42 / $1.42
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.41 / $1.42 / $1.77
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.00 / $1.97 / $3.56
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.13 / $1.42 / $1.53
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.78 / $4.13 / $4.82
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.46 / $1.76 / $1.86
Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.39 / $3.76 / $5.47
Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.46 / $1.46 / $1.83
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.42 / $2.15 / $11.34
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.42 / $1.42 / $2.80
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.42 / $1.42 / $2.57