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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
$1.00 / $6.17 / $316.23
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.00 / $1.00 / $1.41
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.41 / $1.41 / $2.34
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.41 / $1.95 / $3.24
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
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.20 / $1.41 / $1.86
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.45 / $2.45 / $3.47
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.41 / $2.04 / $3.89
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.35 / $1.74 / $3.63
Sentara
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.35 / $1.74 / $3.63
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.34 / $2.34 / $3.89
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.41 / $1.41 / $1.78