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Michigan rates for HCPCS A9577

Injection, gadobenate dimeglumine (MultiHance), per ml

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$30.08 / $72.17 / $159.94
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.73 / $1.80 / $2.60
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.82 / $1.82 / $1.82
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.93 / $2.64 / $4.69
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.68 / $1.77 / $2.12
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.74 / $1.74 / $2.61
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.74 / $2.09 / $4.03
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.74 / $1.74 / $2.06
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.31 / $88.40 / $159.94
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.74 / $1.76 / $2.60
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$100.00 / $100.00 / $100.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.74 / $1.74 / $1.88