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Ohio rates for HCPCS A9576

Injection, gadoteridol, (ProHance multipack), per ml

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.65 / $82.97 / $148.74
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.41 / $1.42 / $2.12
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.13 / $3.32 / $9.23
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.42 / $1.53 / $2.76
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.42 / $1.42 / $2.41
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.42 / $1.42 / $1.92
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.33 / $1.33 / $1.41
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.41 / $1.41 / $3.28
Medical Mutual of Ohio
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.82 / $3.19 / $20.22
Medical Mutual of Ohio
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.41 / $1.41 / $3.86
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.56 / $1.77 / $2.06
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.42 / $1.42 / $1.98