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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
$1.42 / $1.42 / $103.80
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.41 / $1.42 / $2.12
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.33 / $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
$1.56 / $1.88 / $5.64
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.42 / $1.70 / $2.73
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.11 / $1.31 / $2.79
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.42 / $1.70 / $1.78
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.42 / $1.42 / $2.27