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Utah rates for HCPCS A9577

Injection Gadobenate Dimeglumine (Multihance) Per Ml

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.02 / $2.02 / $314.42
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.02 / $2.02 / $2.02
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.11 / $2.70 / $4.30
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.74 / $1.74 / $1.74
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.65 / $2.90 / $60.00
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.74 / $2.14 / $2.25
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.74 / $1.74 / $1.74