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Illinois rates for HCPCS A9577

Injection Gadobenate Dimeglumine (Multihance) Per Ml

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.97 / $133.38 / $372.28
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.73 / $1.74 / $6.63
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.82 / $1.82 / $1.82
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.80 / $13.45 / $75.97
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.31 / $6.31 / $6.31
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.74 / $1.74 / $1.74
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.74 / $1.74 / $1.81
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.74 / $2.61 / $9.84
Hally Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $100.00 / $100.00
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.25 / $2.25 / $2.25
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.82 / $2.48 / $2.73
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.74 / $1.74 / $2.66