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Indiana rates for HCPCS A9576

Injection, gadoteridol, (ProHance multipack), per ml

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.43 / $3.53 / $159.60
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.42 / $1.42 / $1.43
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.90 / $2.90 / $2.90
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.49 / $2.84 / $4.26
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.20 / $1.42 / $2.00
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.42 / $1.42 / $2.13
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.42 / $1.42 / $2.20
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 / $3.86
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.42 / $1.42 / $1.90