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South Dakota 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
$1.42 / $1.42 / $2.12
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.46 / $1.46 / $1.83
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.02 / $2.40 / $3.89
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.42 / $1.42 / $1.56
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.70 / $1.90 / $2.19
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.68 / $2.04 / $3.68
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.54 / $1.54 / $1.54
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.42 / $1.42 / $1.93
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.42 / $1.42 / $1.42