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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
$2.69 / $77.62 / $147.91
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.00 / $1.00 / $1.82
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.07 / $1.07 / $100.00
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.51 / $3.02 / $9.33
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.41 / $1.74 / $2.75
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.41 / $1.41 / $1.41
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.91 / $1.91 / $1.91
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.32 / $1.32 / $1.41
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.41 / $1.41 / $3.31
Medical Mutual of Ohio
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.81 / $1.32 / $8.91
Medical Mutual of Ohio
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.41 / $1.41 / $3.63
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.41 / $1.78 / $2.63
SummaCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.51 / $2.63 / $3.55
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.41 / $1.41 / $1.86