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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
$1.42 / $2.48 / $427.42
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.42 / $1.42 / $1.47
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.56 / $4.47 / $100.00
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.42 / $1.42 / $3.55
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.08 / $3.62 / $6.57
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 / $1.41
Fallon Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.69 / $83.43 / $8,090.00
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.42 / $1.42 / $2.29
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$75.00 / $75.00 / $100.00
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.42 / $1.42 / $7.42
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.42 / $1.42 / $3.28