go back

North Carolina rates for HCPCS A9576

Injection, gadoteridol, (ProHance multipack), per ml

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.42 / $26.95 / $456.24
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.42 / $1.43 / $2.12
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.99 / $3.68 / $5.74
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.12 / $1.12 / $1.50
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.41 / $1.41 / $1.41
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.41 / $1.41 / $2.78
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.43 / $2.29 / $6.56
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.29 / $2.29 / $2.29
Oscar Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$263.37 / $263.37 / $263.37
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.25 / $2.37 / $3.50
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.42 / $1.42 / $1.87
Wellcare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$75.00 / $85.00 / $100.00
Wellcare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.42 / $7.42 / $7.42