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Washington rates for HCPCS A9576

Injection, gadoteridol, (ProHance multipack), per ml

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.00 / $3.72 / $239.88
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.00 / $1.00 / $1.58
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.32 / $1.32 / $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
$1.41 / $2.75 / $3.98
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.41 / $2.82 / $4.27
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.55 / $64.57 / $75.86
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.41 / $1.78 / $2.69
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.63 / $3.63 / $3.63
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.63 / $3.63 / $3.63
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.41 / $1.41 / $1.41
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.41 / $1.41 / $1.41
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.41 / $1.41 / $1.70
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.41 / $1.41 / $1.86