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California rates for HCPCS A9576

Injection, gadoteridol, (ProHance multipack), per ml

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.00 / $7.08 / $13.80
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.00 / $1.41 / $38.02
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.41 / $1.41 / $1.41
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.48 / $1.66 / $3.31
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.41 / $1.51 / $5.62
Blue Shield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.31 / $3.31 / $3.31
Blue Shield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.32 / $2.04 / $4.27
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.32 / $1.32 / $1.41
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.41 / $1.41 / $2.19
Contra Costa Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.41 / $1.41 / $1.55
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.26 / $1.62 / $3.02
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $100.00 / $100.00
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.41 / $7.41 / $7.41
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.45 / $1.45 / $1.45
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.41 / $2.04 / $3.72
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.38 / $1.38 / $2.19
Sutter Health Plus
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.39 / $3.39 / $3.39
The Alliance
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.12 / $1.51 / $2.40
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.79 / $4.79 / $4.79
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.41 / $1.41 / $3.80