go back

Michigan rates for HCPCS A9576

Injection Gadoteridol (Prohance Multipack) Per Ml

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.65 / $92.66 / $291.38
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.41 / $1.46 / $2.12
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.51 / $2.09 / $3.73
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.37 / $1.44 / $1.73
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.41 / $1.41 / $1.67
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.13 / $85.41 / $290.70
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.42 / $1.42 / $1.70
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$100.00 / $100.00 / $100.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.42 / $1.42 / $1.70