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Pennsylvania rates for HCPCS A9583

Injection, gadofosveset trisodium, 1 ml

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$17.86 / $17.86 / $22.68
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17.86 / $17.86 / $17.86
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$16.12 / $18.96 / $8,459.92
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.96 / $19.96 / $19.96
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$85.00 / $85.00 / $85.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.25 / $20.27 / $24.29
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17.86 / $17.86 / $20.14
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$17.86 / $17.86 / $25.54
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17.44 / $17.86 / $22.68
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$85.00 / $85.00 / $85.00
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.25 / $20.27 / $24.29
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.01 / $21.01 / $27.42