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Idaho rates for HCPCS A9576

Injection, gadoteridol, (ProHance multipack), per ml

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.41 / $1.41 / $104.71
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.00 / $1.00 / $1.58
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.45 / $3.72 / $5.25
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.55 / $2.82 / $3.31
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.32 / $1.41 / $1.41
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
$1.41 / $1.51 / $1.82
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.00 / $1.51 / $2.82
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.07 / $1.07 / $1.26
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.35 / $1.41 / $1.78
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.38 / $1.38 / $1.48
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.41 / $1.41 / $2.69