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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
$1.00 / $1.00 / $3.89
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.00 / $1.00 / $1.58
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.45 / $1.45 / $1.78
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.04 / $2.40 / $3.89
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.23 / $1.41 / $1.55
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.70 / $1.70 / $1.70
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.55 / $1.55 / $1.55
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.41 / $1.41 / $1.62
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.41 / $1.41 / $1.41