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Wisconsin rates for HCPCS A9576

Injection Gadoteridol (Prohance Multipack) Per Ml

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.46 / $1.46 / $388.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.41 / $1.42 / $5.21
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.42 / $1.42 / $2.13
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.95 / $2.25 / $2.27
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.41 / $3.60 / $5.11
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.41 / $2.60 / $2.95
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.32 / $1.42 / $1.47
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.60 / $1.60 / $1.60
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.32 / $1.42 / $8.69
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.42 / $1.42 / $3.86
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.41 / $65.00 / $85.00
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.32 / $1.42 / $2.86
Prevea360
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.60 / $1.60 / $1.60
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.41 / $1.80 / $5.40
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $100.00 / $100.00
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.41 / $2.69 / $7.42
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.87 / $1.99 / $2.17
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.42 / $1.42 / $2.13