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Maryland rates for HCPCS A9576

Injection, gadoteridol, (ProHance multipack), per ml

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$43.65 / $43.65 / $43.65
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.00 / $1.00 / $3.89
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.41 / $1.41 / $1.41
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.41 / $1.41 / $1.82
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.20 / $1.41 / $1.70
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.41 / $1.45 / $3.89
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.41 / $1.41 / $1.70
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.45 / $1.45 / $1.62