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New Hampshire rates for HCPCS A9576

Injection, gadoteridol, (ProHance multipack), per ml

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.41 / $1.41 / $1.70
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.00 / $1.00 / $1.41
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.00 / $2.95 / $5.25
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.41 / $1.41 / $1.62
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.32 / $1.41 / $1.41
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.41 / $1.41 / $1.41
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.38 / $1.38 / $2.63
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.41 / $1.41 / $2.19