go back

South Carolina rates for HCPCS A9576

Injection, gadoteridol, (ProHance multipack), per ml

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.48 / $48.98 / $97.72
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.00 / $1.00 / $1.41
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.07 / $0.07 / $2.45
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.45 / $1.82 / $3.89
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.32 / $1.41 / $1.41
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.41 / $1.41 / $1.41
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.41 / $1.82 / $3.89
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.20 / $30.20 / $30.20
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.41 / $1.41 / $1.51