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Oklahoma rates for HCPCS A9576

Injection, gadoteridol, (ProHance multipack), per ml

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.53 / $59.89 / $639.07
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.42 / $1.42 / $1.53
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.60 / $1.60 / $1.60
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 / $1.41
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.42 / $1.61 / $75.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.42 / $1.42 / $1.75
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.42 / $1.42 / $1.57