go back

Washington rates for HCPCS A9576

Injection, gadoteridol, (ProHance multipack), per ml

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.56 / $61.32 / $151.19
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.41 / $1.56 / $2.70
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.42 / $4.47 / $100.00
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.42 / $1.42 / $7.42
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 / $1.74
Kaiser Permanente
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.42 / $2.12 / $4.48
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.42 / $2.33 / $4.48
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.56 / $1.56 / $1.57
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.41 / $1.85 / $4.26
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.67 / $3.67 / $3.67
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.69 / $3.67 / $3.67
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.42 / $1.42 / $1.42
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.35 / $1.42 / $1.42
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.42 / $1.42 / $1.70