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Wisconsin rates for HCPCS Q9964

High osmolar contrast material, 400 or greater mg/ml iodine concentration, per ml

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.41 / $1.41 / $1.41
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.28 / $0.31 / $0.39
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.28 / $0.56 / $1.32
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.28 / $0.40 / $0.49
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.33 / $0.33 / $0.39
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.26 / $1.10 / $1.48
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.33 / $0.35 / $0.79
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.39 / $0.39 / $0.51
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.28 / $50.12 / $70.79
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.28 / $85.11 / $100.00
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.28 / $0.28 / $1.78
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.39 / $0.39 / $0.49