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New Hampshire rates for HCPCS A9577

Injection Gadobenate Dimeglumine (Multihance) Per Ml

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.73 / $1.74 / $323.89
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.73 / $1.74 / $1.74
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.08 / $2.61 / $7.16
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
$1.64 / $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 / $2.64 / $5.37
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.74 / $1.74 / $4.18
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.90 / $7.38 / $3,000.00