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Montana rates for HCPCS A9576

Injection, gadoteridol, (ProHance multipack), per ml

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $141.25 / $186.21
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.00 / $1.00 / $2.14
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.37 / $46,773.51 / $95,499.26
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.91 / $1.91 / $1.91
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.62 / $1.62 / $4.17
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.41 / $1.41 / $1.62
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.58 / $1.62 / $4.37
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.58 / $1.62 / $4.37
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.45 / $1.62 / $4.17
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.51 / $1.62 / $79.43
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.41 / $1.41 / $1.41