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
$1.91 / $43.69 / $89.53
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.41 / $1.43 / $1.49
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.07 / $0.07 / $2.46
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.42 / $3.40 / $4.22
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.33 / $1.33 / $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
$1.49 / $2.90 / $6.56
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.42 / $1.42 / $1.42