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Michigan rates for HCPCS A9576

Injection, gadoteridol, (ProHance multipack), per ml

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9.77 / $89.13 / $114.82
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.00 / $1.00 / $1.58
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.07 / $1.41 / $2.88
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.45 / $2.19 / $3.80
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.38 / $1.45 / $1.51
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.41 / $1.41 / $1.58
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.14 / $83.18 / $288.40
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.00 / $1.48 / $2.00
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.41 / $1.41 / $1.58
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 / $1.51