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Nebraska rates for HCPCS A9576

Injection, gadoteridol, (ProHance multipack), per ml

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.42 / $1.42 / $85.20
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.42 / $1.42 / $5.21
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.36 / $1.60 / $222.92
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.52 / $1.60 / $1.60
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.46 / $1.72 / $2.21
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.47 / $3.68 / $100.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.42 / $1.42 / $3.86
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.66 / $1.72 / $2.10
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.69 / $1.94 / $3.63
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.66 / $1.66 / $2.89
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.35 / $1.42 / $2.13