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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
$1.41 / $2.82 / $85.11
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.00 / $1.00 / $6.76
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.35 / $1.58 / $186.21
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.51 / $1.58 / $1.58
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.45 / $1.70 / $2.19
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.48 / $3.89 / $100.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.41 / $1.41 / $3.89
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.66 / $1.70 / $2.19
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.19 / $3.55 / $3.55
Oscar Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$263.03 / $263.03 / $309.03
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.41 / $1.45 / $3.80
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.35 / $1.41 / $3.89