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Virginia rates for HCPCS A9576

Injection, gadoteridol, (ProHance multipack), per ml

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.42 / $72.56 / $317.51
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.42 / $1.43 / $1.55
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.42 / $1.42 / $1.74
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.41 / $1.41 / $3.45
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
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.21 / $1.57 / $1.85
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.42 / $1.94 / $2.73
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.95 / $3.00 / $4.00
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.35 / $1.72 / $3.67
Sentara
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.35 / $1.72 / $3.67
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.42 / $1.42 / $1.78