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California rates for HCPCS Q9965

Low osmolar contrast material, 100-199 mg/ml iodine concentration, per ml

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.96 / $18.19 / $191.49
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.96 / $0.96 / $5.01
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.02 / $1.32 / $2.11
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.96 / $1.80 / $3.51
Blue Shield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.15 / $2.15 / $2.15
Blue Shield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.75 / $0.94 / $2.67
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.90 / $0.90 / $0.96
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.96 / $0.96 / $1.04
Contra Costa Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.20 / $1.49 / $1.71
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.86 / $1.10 / $1.84
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
$527.24 / $527.24 / $527.24
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.20 / $2.46 / $60.00
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.88 / $0.96 / $1.67
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.96 / $0.96 / $1.87
Sutter Health Plus
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.62 / $1.62 / $1.62
The Alliance
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.77 / $1.49 / $2.24
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.96 / $0.96 / $1.74