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Vermont rates for HCPCS A9576

Injection Gadoteridol (Prohance Multipack) Per Ml

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.42 / $1.42 / $1.57
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.60 / $1.60 / $1.60
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.52 / $1.52 / $1.52
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.33 / $1.62 / $2.71
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.41 / $1.41 / $3.36
MVP Health Care
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.33 / $1.62 / $2.71
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.41 / $1.41 / $3.36
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.42 / $1.42 / $3.28