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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
$1.42 / $1.42 / $2.14
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.42 / $1.42 / $3.97
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.33 / $2.06 / $2.86
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.41 / $1.41 / $1.54
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.42 / $3.17 / $4.25
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.42 / $2.74 / $4.32
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.42 / $1.56 / $1.85
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.41 / $1.85 / $4.26
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.42 / $2.06 / $4.32
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.41 / $1.76 / $2.57
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.42 / $1.42 / $1.42
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.42 / $1.42 / $1.70