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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
$1.00 / $1.00 / $2.14
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.37 / $4.37 / $4.37
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.41 / $1.41 / $1.41
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 / $2.51
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.38 / $1.38 / $1.66
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.00 / $1.41 / $4.68
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.41 / $1.41 / $2.14