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Arkansas rates for HCPCS A9576

Injection, gadoteridol, (ProHance multipack), per ml

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.70 / $204.80 / $353.07
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.42 / $1.57 / $1.70
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.65 / $1.65 / $1.65
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.53 / $1.53 / $1.53
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.49 / $1.53 / $1.53
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.33 / $1.41 / $1.46
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.41 / $1.41 / $1.41
Qualchoice
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.90 / $1.90 / $1.90
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.42 / $1.42 / $3.28