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California rates for HCPCS Q9964

High osmolar contrast material, 400 or greater mg/ml iodine concentration, per ml

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.32 / $0.32 / $2.69
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.32 / $0.33 / $0.51
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.32 / $0.38 / $1.01
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.28 / $0.33 / $0.78
Blue Shield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.72 / $0.72 / $0.81
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.28 / $0.28 / $0.28
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.28 / $0.28 / $0.36
Contra Costa Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.16 / $0.16 / $0.19
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$393.93 / $638.07 / $801.00
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $100.00 / $100.00
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.00 / $1.00 / $1.00
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.30 / $0.61 / $60.00
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.32 / $0.39 / $0.51
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.28 / $0.28 / $0.39
The Alliance
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.16 / $0.16 / $0.24
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.39 / $0.39 / $0.71