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Massachusetts rates for HCPCS A9576

Injection, gadoteridol, (ProHance multipack), per ml

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.00 / $2.45 / $426.58
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.00 / $1.00 / $6.31
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.51 / $4.47 / $6.31
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.38 / $1.41 / $3.47
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.09 / $3.63 / $5.75
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 / $2.09
Fallon Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.70 / $56.23 / $8,511.38
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.38 / $1.38 / $2.29
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.51 / $4.47 / $6.31
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.38 / $1.41 / $3.47
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.45 / $2.34 / $3.09
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.41 / $1.41 / $3.31