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Montana rates for HCPCS A9577

Injection, gadobenate dimeglumine (MultiHance), per ml

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$129.50 / $418.00 / $927.68
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.73 / $1.76 / $27.30
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.03 / $77,999.99 / $94,999.99
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.06 / $2.06 / $5.42
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.74 / $1.74 / $2.06
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.06 / $2.06 / $5.42
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.89 / $1.89 / $2.18
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.74 / $1.74 / $1.74