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Maine rates for HCPCS A9576

Injection, gadoteridol, (ProHance multipack), per ml

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.41 / $1.42 / $2.12
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.38 / $4.38 / $4.38
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.42 / $1.42 / $1.42
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
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.42 / $1.42 / $1.70
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.41 / $1.47 / $1.63
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.42 / $1.42 / $2.39