MultiHance contrast agent injection, 15 mL at Southeast Texas - Jasper Memorial

Hospitals report these codes with terse, inconsistent chargemaster text. This plain-English title was written by an AI model from that text and has not been reviewed by a person, so it can be wrong. The prices on this page come straight from hospital filings and do not depend on it.

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Provider: anthropic
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Max output tokens: 4096
Prompt version (hash): 444523875572
Generated: October 20, 2026

Original text from hospital filings

gadobenate dimeglumine (MULTIHANCE) injection 17.7 mL

Jasper, TX

See all hospitals reporting HCPCS A9577 →

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How this price compares nationally

Southeast Texas - Jasper Memorial’s median price of $474 is 5825% above the median hospital's median price ($8), higher than 97% of the 1,604 hospitals reporting HCPCS A9577. The highlighted bar is where this hospital falls; shaded is the middle 50% of hospitals.

Payers reporting HCPCS A9577 at Southeast Texas - Jasper Memorial

Negotiated rates from the hospital’s own file: 11 payers, 23 plan rates. A facility fee, a professional fee, a per diem and a case rate are different bills, so each is listed on its own. Open a payer to see it across hospitals.

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1	UnitedHealthcare all payer fee schedule · outpatient	$2	$2	—	—	—	$2 – $2
2	UnitedHealthcare hix fee schedule · outpatient	$2	$2	—	—	—	$2 – $2
3	Humana choicecare fee schedule · outpatient	$5	$5	—	—	—	$5 – $5
4	Bcbs Tx blue advantage hmo fee schedule · outpatient	$10	$10	—	—	—	$10 – $10
5	Bcbs Tx heb fee schedule · outpatient	$10	$10	—	—	—	$10 – $10
6	Bcbs Tx hmo fee schedule · outpatient	$10	$10	—	—	—	$10 – $10
7	Bcbs Tx ppo fee schedule · outpatient	$12	$12	—	—	—	$12 – $12
8	Bcbs Tx traditional fee schedule · outpatient	$12	$12	—	—	—	$12 – $12
9	UnitedHealthcare chip km percent of total billed charges · outpatientfrom % of charges	$221	$221	—	—	—	$221 – $221
10	UnitedHealthcare star kid km percent of total billed charges · outpatientfrom % of charges	$221	$221	—	—	—	$221 – $221
11	UnitedHealthcare star km percent of total billed charges · outpatientfrom % of charges	$221	$221	—	—	—	$221 – $221
12	UnitedHealthcare star plus km percent of total billed charges · outpatientfrom % of charges	$221	$221	—	—	—	$221 – $221
13	Aetna mm percent of total billed charges · outpatientfrom % of charges	$379	$379	—	—	—	$379 – $379
14	Molina chip km percent of total billed charges · outpatientfrom % of charges	$474	$474	—	—	—	$474 – $474
15	Molina star km percent of total billed charges · outpatientfrom % of charges	$474	$474	—	—	—	$474 – $474
16	Molina star plus km percent of total billed charges · outpatientfrom % of charges	$474	$474	—	—	—	$474 – $474
17	Cigna new business percent of total billed charges · outpatientfrom % of charges	$617	$617	—	—	—	$617 – $617
18	Healthcare Highways ppo percent of total billed charges · outpatientfrom % of charges	$711	$711	—	—	—	$711 – $711
19	Devoted mm percent of total billed charges · outpatientfrom % of charges	$790	$790	—	—	—	$790 – $790
20	Cigna ppo percent of total billed charges · outpatientfrom % of charges	$949	$949	—	—	—	$949 – $949
21	First Health ppo percent of total billed charges · outpatientfrom % of charges	$1.0k	$1.0k	—	—	—	$1.0k – $1.0k
22	MultiPlan ppo percent of total billed charges · outpatientfrom % of charges	$1.0k	$1.0k	—	—	—	$1.0k – $1.0k
23	Phcs ppo percent of total billed charges · outpatientfrom % of charges	$1.0k	$1.0k	—	—	—	$1.0k – $1.0k

Last updated: Jan 13, 2026

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