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Missouri rates for HCPCS A9576

Injection, gadoteridol, (ProHance multipack), per ml

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.42 / $2.92 / $4.05
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.42 / $1.44 / $4.05
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.55 / $2.41 / $3.74
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.42 / $1.42 / $1.78
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.33 / $1.33 / $1.41
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.41 / $1.41 / $1.67
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.43 / $2.60 / $100.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.22 / $1.42 / $2.19
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.42 / $1.42 / $1.77