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Pennsylvania rates for HCPCS A9576

Injection, gadoteridol, (ProHance multipack), per ml

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.82 / $295.12 / $851.14
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.00 / $1.00 / $3.89
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.75 / $6.76 / $5,011.87
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.76 / $6.76 / $6.76
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.41 / $1.41 / $1.41
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.41 / $1.41 / $1.41
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.29 / $1.51 / $1.74
Geisinger
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.41 / $1.41 / $1.41
Geisinger
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.62 / $2.45 / $3.72
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$42.66 / $60.26 / $64.57
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.82 / $302.00 / $912.01
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.00 / $1.00 / $2.29
Oscar Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$154.88 / $158.49 / $371.54
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.60 / $2.45 / $3.02
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.71 / $1.62 / $10.72
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.71 / $1.62 / $10.72
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.41 / $1.41 / $3.31