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California rates for HCPCS A9577

Injection, gadobenate dimeglumine (MultiHance), per ml

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.76 / $134.84 / $453.77
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.74 / $1.76 / $27.30
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.57 / $1.91 / $2.50
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.74 / $1.77 / $5.91
Blue Shield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.17 / $4.17 / $4.17
Blue Shield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.64 / $1.82 / $5.08
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.64 / $1.64 / $1.74
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.74 / $1.74 / $2.67
Contra Costa Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.82 / $1.84 / $2.46
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.57 / $2.00 / $3.48
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$85.00 / $100.00 / $100.00
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.00 / $12.00 / $12.00
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.73 / $3.73 / $3.73
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.64 / $1.74 / $3.36
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.74 / $1.74 / $2.67
Sutter Health Plus
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.11 / $4.11 / $4.11
The Alliance
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.39 / $1.92 / $3.13
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.74 / $1.74 / $4.16