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Oregon rates for HCPCS A9576

Injection, gadoteridol, (ProHance multipack), per ml

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.00 / $1.41 / $1.55
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.00 / $1.00 / $1.58
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.32 / $2.04 / $2.88
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.41 / $1.41 / $2.00
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.41 / $3.16 / $4.27
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.41 / $1.51 / $2.04
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.41 / $1.51 / $2.69
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.41 / $1.86 / $2.95
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.41 / $2.04 / $4.37
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.38 / $1.74 / $79.43
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.41 / $1.41 / $1.41
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.41 / $1.41 / $1.70