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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
$1.42 / $1.42 / $1.70
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.41 / $1.42 / $3.97
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.70 / $2.13 / $5.84
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.42 / $1.42 / $1.42
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.33 / $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
$1.42 / $2.15 / $4.38
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.42 / $1.42 / $3.28
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.20 / $7.90 / $3,000.00