go back

West Virginia rates for HCPCS A9576

Injection, gadoteridol, (ProHance multipack), per ml

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8.28 / $91.11 / $155.83
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.41 / $1.42 / $1.55
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.42 / $2.13 / $2.13
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.30 / $3.30 / $3.30
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.33 / $1.41 / $85.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.41 / $1.41 / $2.78
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.54 / $3.24 / $14.08
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.42 / $1.42 / $3.86