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Utah rates for HCPCS A9576

Injection, gadoteridol, (ProHance multipack), per ml

Facilitymedian $813 · 10th–90th $3$9330%20%10th90th$813Professionalmedian $1 · 10th–90th $1$20%50%90th$1$1.0$5.0$20.0$100.0$500.0

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Setting
Facility
Modifier
Global
Typical Low
$77.62
Median
$812.83
Typical High
$933.25
Aetna
Setting
Professional
Modifier
Global
Typical Low
$1.00
Median
$1.00
Typical High
$1.00
Cigna
Setting
Facility
Modifier
Global
Typical Low
$1.66
Median
$2.04
Typical High
$3.39
Cigna
Setting
Professional
Modifier
Global
Typical Low
$1.38
Median
$1.38
Typical High
$1.38
Molina
Setting
Professional
Modifier
Global
Typical Low
$2.04
Median
$2.24
Typical High
$60.26
Regence BlueShield
Setting
Professional
Modifier
Global
Typical Low
$1.38
Median
$1.38
Typical High
$1.86
Select Health
Setting
Professional
Modifier
Global
Typical Low
$1.48
Median
$1.55
Typical High
$4.07
U of Utah Health Plan
Setting
Professional
Modifier
Global
Typical Low
$1.26
Median
$1.38
Typical High
$1.70
United
Setting
Professional
Modifier
Global
Typical Low
$1.41
Median
$1.41
Typical High
$1.41