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Maine rates for HCPCS A9577

Injection, gadobenate dimeglumine (MultiHance), per ml

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.93 / $98.82 / $256.89
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.73 / $1.76 / $2.60
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.38 / $5.38 / $5.38
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.74 / $1.74 / $1.74
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 / $1.74
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.74 / $1.74 / $2.08
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.93 / $98.82 / $780.86
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.73 / $1.76 / $2.60
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.74 / $1.74 / $2.87