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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
$1.00 / $1.41 / $575.44
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.00 / $1.00 / $1.41
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.51 / $1.51 / $1.51
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.51 / $1.51 / $1.51
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$21.88 / $21.88 / $39.81
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.32 / $1.32 / $1.41
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.41 / $1.41 / $1.41
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.23 / $1.51 / $1.74
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.41 / $1.41 / $2.40