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Texas rates for HCPCS A9577

Injection, gadobenate dimeglumine (MultiHance), per ml

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.76 / $117.70 / $401.83
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.74 / $1.76 / $2.60
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.18 / $2.18 / $2.18
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.02 / $4.92 / $10.71
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.02 / $2.02 / $2.02
Baylor Scott & White
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.67 / $1.74 / $146.56
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$69.45 / $69.45 / $69.45
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
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$85.00 / $100.00 / $100.00
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.00 / $12.00 / $12.00
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.74 / $2.49 / $8.09
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.53 / $1.88 / $6.00
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.74 / $1.94 / $2.88
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.74 / $1.74 / $4.21
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
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.74 / $1.82 / $2.35