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New Mexico rates for HCPCS A9577

Injection Gadobenate Dimeglumine (Multihance) Per Ml

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$81.86 / $345.80 / $427.70
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.73 / $2.21 / $27.30
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$56,799.99 / $68,899.99 / $81,099.99
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.55 / $2.06 / $2.20
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
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.21 / $2.21 / $2.97
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.74 / $2.25 / $6.31
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.74 / $1.74 / $1.74
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.74 / $1.74 / $1.74