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Arizona rates for HCPCS A9576

Injection, gadoteridol, (ProHance multipack), per ml

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.41 / $1.56 / $5.21
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.42 / $1.42 / $1.42
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.61 / $2.31 / $3.66
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.81 / $1.08 / $5.23
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.41 / $1.41 / $1.41
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.41 / $1.41 / $1.47
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.42 / $2.23 / $100.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.42 / $1.42 / $3.86
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.42 / $1.42 / $1.42