Gadoteridol contrast injection (ProHance multipack), per milliliter

Hospitals report these codes with terse, inconsistent chargemaster text. This plain-English title was written by an AI model from that text and has not been reviewed by a person, so it can be wrong. The prices on this page come straight from hospital filings and do not depend on it.

Model: claude-haiku-5-5
Provider: anthropic
API: message_batches
Reasoning effort: low
Max output tokens: 4096
Prompt version (hash): 444523875572
Generated: October 20, 2026

Original text from hospital filings

GADOTERIDOL 279MG 1ML INJ

Payers reporting HCPCS A9576

Payer pricing summary

Low

Average

$202

Median

$142

High

$927

Payer rate distribution

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#
1	Blue Cross Blue Shield fee schedule · outpatient · +19 other terms	187	$4	$6	$13	202%	1,494–1,512	$1 – $221
2	Anthem fee schedule · outpatient · +15 other terms	52	$2	$5	$11	212%	4–40	$1 – $135
3	UnitedHealthcare fee schedule · outpatient · +21 other terms	361	$2	$16	$73	466%	3–30	$1 – $435
4	Cigna fee schedule · outpatient · +17 other terms	282	$2	$4	$5	111%	2–20	$0 – $66
5	Humana fee schedule · outpatient · +16 other terms	141	$1	$7	$16	243%	—	$1 – $155
6	Aetna fee schedule · outpatient · +21 other terms	119	$3	$5	$10	210%	—	$1 – $140
7	Caresource fee schedule · outpatient · +9 other terms	50	$2	$245	$214	87%	—	$1 – $435
8	Kaiser fee schedule · both · +11 other terms	41	$2	$2	$0	26%	—	$1 – $2
9	Bcbs Tx fee schedule · outpatient · +2 other terms	30	$7	$6	$2	33%	—	$3 – $11
10	Molina fee schedule · outpatient · +13 other terms	27	$4	$4	$5	132%	—	$1 – $34
11	Baylor Scott White Health Plan facility · percent of total billed charges · inpatientfrom % of charges · +1 other terms	26	$306	$272	$43	16%	—	$213 – $331
12	Highmark facility · fee schedule · outpatient · +10 other terms	23	$4	$30	$27	90%	—	$1 – $108
13	Regence professional · fee schedule · outpatient · +6 other terms	21	$1	$1	$0	4%	—	$1 – $2
14	Healthpartners fee schedule · outpatient · +2 other terms	18	$2	$2	$0	2%	—	$2 – $2
15	Medcost percent of total billed charges · inpatientfrom % of charges · +2 other terms	14	$418	$476	$195	41%	—	$162 – $1.3k
16	WellCare professional · fee schedule · outpatient · +10 other terms	14	$1	$1	$0	1%	—	$1 – $1
17	Wellmark fee schedule · both · +1 other terms	14	$1	$1	$0	26%	—	$1 – $4
18	Beechstreet percent of total billed charges · inpatientfrom % of charges · +3 other terms	13	$666	$667	$19	3%	—	$643 – $710
19	Medical Mutual facility · fee schedule · outpatient · +5 other terms	13	$4	$4	$1	26%	—	$2 – $6
20	MultiPlan fee schedule · inpatient · +12 other terms	13	$28	$41	$32	77%	—	$8 – $98
21	Bcbs Mn fee schedule · outpatient · +3 other terms	12	$2	$2	$1	37%	—	$1 – $2
22	Aetna Better Health fee schedule · outpatient · +7 other terms	11	$2	$2	$0	10%	—	$2 – $2
23	Bcbs Nj fee schedule · outpatient · +2 other terms	11	$1	$1	—	—	—	$1 – $1
24	First Health fee schedule · inpatient · +10 other terms	11	$23	$29	$22	78%	—	$8 – $84
25	Medica fee schedule · outpatient · +8 other terms	11	$3	$15	$53	355%	—	$2 – $338

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