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Louisiana rates for HCPCS A9576

Injection Gadoteridol (Prohance Multipack) Per Ml

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.42 / $1.46 / $481.69
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.41 / $1.42 / $2.12
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.36 / $2.75 / $3.10
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.57 / $1.57 / $1.60
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$22.04 / $22.04 / $22.04
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.33 / $1.33 / $1.41
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.41 / $1.41 / $1.41
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.42 / $1.42 / $2.97