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Pennsylvania rates for HCPCS A9577

Injection, gadobenate dimeglumine (MultiHance), per ml

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$28.88 / $248.30 / $459.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.74 / $1.74 / $6.28
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.92 / $6.96 / $8,459.92
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.96 / $6.96 / $6.96
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 / $1.81
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.80 / $1.89 / $2.15
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.99 / $40.61 / $54.01
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$23.07 / $270.00 / $486.55
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.74 / $1.76 / $27.30
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.58 / $2.84 / $4.13
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.64 / $1.74 / $1.74
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.74 / $1.74 / $1.95
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.84 / $1.84 / $2.14
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.84 / $1.84 / $2.14
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.74 / $1.74 / $3.18