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Texas rates for HCPCS A9576

Injection, gadoteridol, (ProHance multipack), per ml

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.42 / $5.38 / $513.83
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.42 / $1.43 / $1.80
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.69 / $4.09 / $8.01
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.59 / $1.59 / $1.59
Baylor Scott & White
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.33 / $1.42 / $70.65
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$22.04 / $22.04 / $22.04
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
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$85.00 / $100.00 / $100.00
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.42 / $7.42 / $7.42
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.42 / $1.54 / $4.05
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.22 / $1.45 / $1.78
Oscar Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$396.61 / $512.26 / $1,243.20
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.42 / $1.53 / $3.18
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.33 / $1.42 / $3.25
Providence
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
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.42 / $1.46 / $1.92