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New Mexico rates for HCPCS A9576

Injection, gadoteridol, (ProHance multipack), per ml

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.76 / $46.77 / $263.03
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.00 / $1.00 / $1.41
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$56,234.13 / $69,183.10 / $81,283.05
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.26 / $1.66 / $1.82
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.41 / $1.41 / $1.41
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.41 / $1.41 / $1.41
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.45 / $1.95 / $60.26
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.38 / $2.51 / $3.47
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.38 / $1.38 / $1.38
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.41 / $1.41 / $1.41
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.41 / $1.41 / $1.45