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Minnesota rates for HCPCS A9576

Injection, gadoteridol, (ProHance multipack), per ml

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.00 / $1.00 / $1.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.00 / $1.00 / $1.41
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.45 / $2.95 / $2.95
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.12 / $1.41 / $1.45
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.69 / $4.37 / $5.01
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.45 / $1.62 / $1.82
Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.80 / $3.98 / $5.62
Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.45 / $1.45 / $1.95
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.41 / $2.40 / $11.22
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.41 / $1.41 / $2.82
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.41 / $1.41 / $2.63