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Utah rates for HCPCS A9576

Injection, gadoteridol, (ProHance multipack), per ml

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.64 / $73.05 / $831.51
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.64 / $1.64 / $1.64
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.67 / $2.22 / $3.40
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.41 / $1.41 / $1.41
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.04 / $2.24 / $60.00
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.42 / $1.75 / $1.84
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.35 / $1.42 / $1.42