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Rhode Island rates for HCPCS A9576

Injection Gadoteridol (Prohance Multipack) Per Ml

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$29.40 / $29.40 / $29.40
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.42 / $1.47 / $1.47
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.42 / $1.42 / $3.28
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.42 / $1.42 / $1.42
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.33 / $1.41 / $1.41
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.41 / $1.41 / $1.41
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.42 / $1.42 / $1.42