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Alaska rates for HCPCS A9576

Injection, gadoteridol, (ProHance multipack), per ml

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.41 / $2.63 / $38.32
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.41 / $1.41 / $1.41
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.76 / $3.76 / $3.76
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.42 / $1.42 / $4.57
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.21 / $5.40 / $8.49
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.22 / $5.40 / $12.74
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.41 / $1.41 / $1.53
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.42 / $2.13 / $2.86