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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
$1.00 / $5.37 / $295.12
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.00 / $1.00 / $1.55
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.74 / $4.07 / $7.94
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.58 / $1.58 / $1.58
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$21.88 / $21.88 / $21.88
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
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $100.00 / $100.00
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.41 / $7.41 / $7.41
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.41 / $1.78 / $144.54
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.00 / $1.00 / $1.78
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.00 / $1.00 / $1.00
Oscar Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$446.68 / $1,230.27 / $1,258.93
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.41 / $2.04 / $4.37
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.38 / $1.38 / $1.38
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.41 / $1.41 / $1.45
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.41 / $1.41 / $1.41