go back

Arizona rates for HCPCS A9576

Injection, gadoteridol, (ProHance multipack), per ml

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.00 / $1.00 / $6.31
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.41 / $1.41 / $1.41
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.56 / $1.82 / $2.69
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.07 / $1.07 / $5.25
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 / $1.48
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.41 / $2.24 / $75.86
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.41 / $1.41 / $7.41
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.41 / $2.34 / $2.34
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.41 / $1.41 / $1.45