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New Jersey rates for HCPCS A9576

Injection, gadoteridol, (ProHance multipack), per ml

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.82 / $9.12 / $87.10
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.00 / $1.00 / $28.84
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.41 / $1.41 / $1.41
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.32 / $1.66 / $2.14
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.41 / $1.41 / $1.55
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.29 / $1.51 / $1.51
Horizon BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15.14 / $6,309.57 / $13,803.84
Horizon BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.41 / $1.45 / $1.45
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.14 / $2.95 / $2.95
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.41 / $1.41 / $1.51