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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
$1.41 / $3.55 / $229.09
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.00 / $1.00 / $1.41
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.07 / $1.07 / $2.88
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.66 / $2.14 / $3.24
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.41 / $1.41 / $2.34
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.41 / $2.14 / $2.82
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 / $1.74
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.34 / $2.34 / $3.89
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.41 / $1.41 / $1.91