|
GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION [41137]
|
Facility
OP
|
$6.81
|
|
|
Service Code
|
CPT A9577
|
| Hospital Charge Code |
NDG41137C
|
|
Hospital Revenue Code
|
255
|
| Min. Negotiated Rate |
$1.63 |
| Max. Negotiated Rate |
$11.66 |
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5.79
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3.75
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11.66
|
| Rate for Payer: BCBS Transplant Transplant |
$4.09
|
| Rate for Payer: Blue Shield of California Commercial |
$5.02
|
| Rate for Payer: Blue Shield of California EPN |
$3.98
|
| Rate for Payer: Cash Price |
$3.06
|
| Rate for Payer: Cash Price |
$3.06
|
| Rate for Payer: Cigna of CA HMO |
$4.36
|
| Rate for Payer: Cigna of CA PPO |
$5.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.79
|
| Rate for Payer: Dignity Health Media |
$5.79
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.72
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.72
|
| Rate for Payer: Galaxy Health WC |
$5.79
|
| Rate for Payer: Global Benefits Group Commercial |
$4.09
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$5.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.63
|
| Rate for Payer: Multiplan Commercial |
$5.45
|
| Rate for Payer: Networks By Design Commercial |
$4.43
|
| Rate for Payer: Prime Health Services Commercial |
$5.79
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$4.09
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.09
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.09
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.40
|
| Rate for Payer: United Healthcare All Other HMO |
$3.40
|
| Rate for Payer: United Healthcare HMO Rider |
$3.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.79
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.79
|
| Rate for Payer: Vantage Medical Group Senior |
$5.79
|
|
|
GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION [41137]
|
Facility
IP
|
$6.31
|
|
|
Service Code
|
CPT A9577
|
| Hospital Charge Code |
NDG41137D
|
|
Hospital Revenue Code
|
255
|
| Min. Negotiated Rate |
$1.51 |
| Max. Negotiated Rate |
$5.36 |
| Rate for Payer: Blue Shield of California Commercial |
$4.49
|
| Rate for Payer: Blue Shield of California EPN |
$3.23
|
| Rate for Payer: Cash Price |
$2.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.52
|
| Rate for Payer: Galaxy Health WC |
$5.36
|
| Rate for Payer: Global Benefits Group Commercial |
$3.79
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.51
|
| Rate for Payer: Multiplan Commercial |
$5.05
|
| Rate for Payer: Networks By Design Commercial |
$4.10
|
| Rate for Payer: Prime Health Services Commercial |
$5.36
|
|
|
GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION [41137]
|
Facility
OP
|
$6.98
|
|
|
Service Code
|
CPT A9577
|
| Hospital Charge Code |
NDG41137B
|
|
Hospital Revenue Code
|
255
|
| Min. Negotiated Rate |
$1.68 |
| Max. Negotiated Rate |
$11.66 |
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5.93
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3.84
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11.66
|
| Rate for Payer: BCBS Transplant Transplant |
$4.19
|
| Rate for Payer: Blue Shield of California Commercial |
$5.14
|
| Rate for Payer: Blue Shield of California EPN |
$4.08
|
| Rate for Payer: Cash Price |
$3.14
|
| Rate for Payer: Cash Price |
$3.14
|
| Rate for Payer: Cigna of CA HMO |
$4.47
|
| Rate for Payer: Cigna of CA PPO |
$5.17
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.93
|
| Rate for Payer: Dignity Health Media |
$5.93
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.79
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.79
|
| Rate for Payer: Galaxy Health WC |
$5.93
|
| Rate for Payer: Global Benefits Group Commercial |
$4.19
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$5.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.68
|
| Rate for Payer: Multiplan Commercial |
$5.58
|
| Rate for Payer: Networks By Design Commercial |
$4.54
|
| Rate for Payer: Prime Health Services Commercial |
$5.93
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$4.19
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.19
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.19
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.49
|
| Rate for Payer: United Healthcare All Other HMO |
$3.49
|
| Rate for Payer: United Healthcare HMO Rider |
$3.49
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.49
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.93
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.93
|
| Rate for Payer: Vantage Medical Group Senior |
$5.93
|
|
|
GADOBENATE DIMEGLUMINE 529 MG/ML(0.1 MMOL/0.2 ML) INTRAVENOUS SOLUTION [41137]
|
Facility
IP
|
$6.81
|
|
|
Service Code
|
CPT A9577
|
| Hospital Charge Code |
NDG41137C
|
|
Hospital Revenue Code
|
255
|
| Min. Negotiated Rate |
$1.63 |
| Max. Negotiated Rate |
$5.79 |
| Rate for Payer: Blue Shield of California Commercial |
$4.85
|
| Rate for Payer: Blue Shield of California EPN |
$3.49
|
| Rate for Payer: Cash Price |
$3.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.72
|
| Rate for Payer: Galaxy Health WC |
$5.79
|
| Rate for Payer: Global Benefits Group Commercial |
$4.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.63
|
| Rate for Payer: Multiplan Commercial |
$5.45
|
| Rate for Payer: Networks By Design Commercial |
$4.43
|
| Rate for Payer: Prime Health Services Commercial |
$5.79
|
|
|
GADOBUTROL 10 MMOL/10 ML (1 MMOL/ML) INTRAVENOUS SOLUTION [121917]
|
Facility
OP
|
$9.96
|
|
|
Service Code
|
CPT A9585
|
| Hospital Charge Code |
NDG121917
|
|
Hospital Revenue Code
|
255
|
| Min. Negotiated Rate |
$0.63 |
| Max. Negotiated Rate |
$8.47 |
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$8.47
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$5.48
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$5.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.78
|
| Rate for Payer: BCBS Transplant Transplant |
$5.98
|
| Rate for Payer: Blue Shield of California Commercial |
$7.34
|
| Rate for Payer: Blue Shield of California EPN |
$5.82
|
| Rate for Payer: Cash Price |
$4.48
|
| Rate for Payer: Cash Price |
$4.48
|
| Rate for Payer: Cigna of CA HMO |
$6.37
|
| Rate for Payer: Cigna of CA PPO |
$7.37
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.47
|
| Rate for Payer: Dignity Health Media |
$8.47
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.98
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.98
|
| Rate for Payer: Galaxy Health WC |
$8.47
|
| Rate for Payer: Global Benefits Group Commercial |
$5.98
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$7.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.39
|
| Rate for Payer: Multiplan Commercial |
$7.97
|
| Rate for Payer: Networks By Design Commercial |
$6.47
|
| Rate for Payer: Prime Health Services Commercial |
$8.47
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$5.98
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.98
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.98
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.98
|
| Rate for Payer: United Healthcare All Other HMO |
$4.98
|
| Rate for Payer: United Healthcare HMO Rider |
$4.98
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.47
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.47
|
| Rate for Payer: Vantage Medical Group Senior |
$8.47
|
|
|
GADOBUTROL 10 MMOL/10 ML (1 MMOL/ML) INTRAVENOUS SOLUTION [121917]
|
Facility
IP
|
$9.96
|
|
|
Service Code
|
CPT A9585
|
| Hospital Charge Code |
NDG121917
|
|
Hospital Revenue Code
|
255
|
| Min. Negotiated Rate |
$2.39 |
| Max. Negotiated Rate |
$8.47 |
| Rate for Payer: Blue Shield of California Commercial |
$7.09
|
| Rate for Payer: Blue Shield of California EPN |
$5.10
|
| Rate for Payer: Cash Price |
$4.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.98
|
| Rate for Payer: Galaxy Health WC |
$8.47
|
| Rate for Payer: Global Benefits Group Commercial |
$5.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.39
|
| Rate for Payer: Multiplan Commercial |
$7.97
|
| Rate for Payer: Networks By Design Commercial |
$6.47
|
| Rate for Payer: Prime Health Services Commercial |
$8.47
|
|
|
GADOBUTROL 7.5 MMOL/7.5 ML (1 MMOL/ML) INTRAVENOUS SOLUTION [121916]
|
Facility
OP
|
$9.96
|
|
|
Service Code
|
CPT A9585
|
| Hospital Charge Code |
NDG121926
|
|
Hospital Revenue Code
|
255
|
| Min. Negotiated Rate |
$0.63 |
| Max. Negotiated Rate |
$8.47 |
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$8.47
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$5.48
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$5.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.78
|
| Rate for Payer: BCBS Transplant Transplant |
$5.98
|
| Rate for Payer: Blue Shield of California Commercial |
$7.34
|
| Rate for Payer: Blue Shield of California EPN |
$5.82
|
| Rate for Payer: Cash Price |
$4.48
|
| Rate for Payer: Cash Price |
$4.48
|
| Rate for Payer: Cigna of CA HMO |
$6.37
|
| Rate for Payer: Cigna of CA PPO |
$7.37
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.47
|
| Rate for Payer: Dignity Health Media |
$8.47
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.98
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.98
|
| Rate for Payer: Galaxy Health WC |
$8.47
|
| Rate for Payer: Global Benefits Group Commercial |
$5.98
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$7.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.39
|
| Rate for Payer: Multiplan Commercial |
$7.97
|
| Rate for Payer: Networks By Design Commercial |
$6.47
|
| Rate for Payer: Prime Health Services Commercial |
$8.47
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$5.98
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.98
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.98
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.98
|
| Rate for Payer: United Healthcare All Other HMO |
$4.98
|
| Rate for Payer: United Healthcare HMO Rider |
$4.98
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.47
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.47
|
| Rate for Payer: Vantage Medical Group Senior |
$8.47
|
|
|
GADOBUTROL 7.5 MMOL/7.5 ML (1 MMOL/ML) INTRAVENOUS SOLUTION [121916]
|
Facility
IP
|
$9.96
|
|
|
Service Code
|
CPT A9585
|
| Hospital Charge Code |
NDG121926
|
|
Hospital Revenue Code
|
255
|
| Min. Negotiated Rate |
$2.39 |
| Max. Negotiated Rate |
$8.47 |
| Rate for Payer: Blue Shield of California Commercial |
$7.09
|
| Rate for Payer: Blue Shield of California EPN |
$5.10
|
| Rate for Payer: Cash Price |
$4.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.98
|
| Rate for Payer: Galaxy Health WC |
$8.47
|
| Rate for Payer: Global Benefits Group Commercial |
$5.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.39
|
| Rate for Payer: Multiplan Commercial |
$7.97
|
| Rate for Payer: Networks By Design Commercial |
$6.47
|
| Rate for Payer: Prime Health Services Commercial |
$8.47
|
|
|
GADODIAMIDE 10 MMOL/20 ML (287 MG/ML) INTRAVENOUS SOLUTION [119868]
|
Facility
IP
|
$6.18
|
|
|
Service Code
|
CPT A9579
|
| Hospital Charge Code |
NDG119868
|
|
Hospital Revenue Code
|
255
|
| Min. Negotiated Rate |
$1.48 |
| Max. Negotiated Rate |
$5.25 |
| Rate for Payer: Blue Shield of California Commercial |
$4.40
|
| Rate for Payer: Blue Shield of California EPN |
$3.16
|
| Rate for Payer: Cash Price |
$2.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.47
|
| Rate for Payer: Galaxy Health WC |
$5.25
|
| Rate for Payer: Global Benefits Group Commercial |
$3.71
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.48
|
| Rate for Payer: Multiplan Commercial |
$4.94
|
| Rate for Payer: Networks By Design Commercial |
$4.02
|
| Rate for Payer: Prime Health Services Commercial |
$5.25
|
|
|
GADODIAMIDE 10 MMOL/20 ML (287 MG/ML) INTRAVENOUS SOLUTION [119868]
|
Facility
OP
|
$6.18
|
|
|
Service Code
|
CPT A9579
|
| Hospital Charge Code |
NDG119868
|
|
Hospital Revenue Code
|
255
|
| Min. Negotiated Rate |
$1.48 |
| Max. Negotiated Rate |
$7.64 |
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5.25
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3.40
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.64
|
| Rate for Payer: BCBS Transplant Transplant |
$3.71
|
| Rate for Payer: Blue Shield of California Commercial |
$4.55
|
| Rate for Payer: Blue Shield of California EPN |
$3.61
|
| Rate for Payer: Cash Price |
$2.78
|
| Rate for Payer: Cash Price |
$2.78
|
| Rate for Payer: Cigna of CA HMO |
$3.96
|
| Rate for Payer: Cigna of CA PPO |
$4.57
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.25
|
| Rate for Payer: Dignity Health Media |
$5.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.47
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.47
|
| Rate for Payer: Galaxy Health WC |
$5.25
|
| Rate for Payer: Global Benefits Group Commercial |
$3.71
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$4.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.48
|
| Rate for Payer: Multiplan Commercial |
$4.94
|
| Rate for Payer: Networks By Design Commercial |
$4.02
|
| Rate for Payer: Prime Health Services Commercial |
$5.25
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$3.71
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.71
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.71
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.09
|
| Rate for Payer: United Healthcare All Other HMO |
$3.09
|
| Rate for Payer: United Healthcare HMO Rider |
$3.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.25
|
| Rate for Payer: Vantage Medical Group Senior |
$5.25
|
|
|
GADODIAMIDE 5 MMOL/10 ML (287 MG/ML) INTRAVENOUS SOLUTION [11929]
|
Facility
IP
|
$6.82
|
|
|
Service Code
|
CPT A9579
|
| Hospital Charge Code |
NDG11929
|
|
Hospital Revenue Code
|
255
|
| Min. Negotiated Rate |
$1.64 |
| Max. Negotiated Rate |
$5.80 |
| Rate for Payer: Blue Shield of California Commercial |
$4.86
|
| Rate for Payer: Blue Shield of California EPN |
$3.49
|
| Rate for Payer: Cash Price |
$3.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.73
|
| Rate for Payer: Galaxy Health WC |
$5.80
|
| Rate for Payer: Global Benefits Group Commercial |
$4.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.64
|
| Rate for Payer: Multiplan Commercial |
$5.46
|
| Rate for Payer: Networks By Design Commercial |
$4.43
|
| Rate for Payer: Prime Health Services Commercial |
$5.80
|
|
|
GADODIAMIDE 5 MMOL/10 ML (287 MG/ML) INTRAVENOUS SOLUTION [11929]
|
Facility
OP
|
$6.82
|
|
|
Service Code
|
CPT A9579
|
| Hospital Charge Code |
NDG11929
|
|
Hospital Revenue Code
|
255
|
| Min. Negotiated Rate |
$1.64 |
| Max. Negotiated Rate |
$7.64 |
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5.80
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3.75
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.64
|
| Rate for Payer: BCBS Transplant Transplant |
$4.09
|
| Rate for Payer: Blue Shield of California Commercial |
$5.03
|
| Rate for Payer: Blue Shield of California EPN |
$3.98
|
| Rate for Payer: Cash Price |
$3.07
|
| Rate for Payer: Cash Price |
$3.07
|
| Rate for Payer: Cigna of CA HMO |
$4.36
|
| Rate for Payer: Cigna of CA PPO |
$5.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.80
|
| Rate for Payer: Dignity Health Media |
$5.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.73
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.73
|
| Rate for Payer: Galaxy Health WC |
$5.80
|
| Rate for Payer: Global Benefits Group Commercial |
$4.09
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$5.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.64
|
| Rate for Payer: Multiplan Commercial |
$5.46
|
| Rate for Payer: Networks By Design Commercial |
$4.43
|
| Rate for Payer: Prime Health Services Commercial |
$5.80
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$4.09
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.09
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.09
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.41
|
| Rate for Payer: United Healthcare All Other HMO |
$3.41
|
| Rate for Payer: United Healthcare HMO Rider |
$3.41
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.41
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.80
|
| Rate for Payer: Vantage Medical Group Senior |
$5.80
|
|
|
GADODIAMIDE 7.5 MMOL/15 ML (287 MG/ML) INTRAVENOUS SOLUTION [119867]
|
Facility
IP
|
$6.67
|
|
|
Service Code
|
CPT A9579
|
| Hospital Charge Code |
NDG119867
|
|
Hospital Revenue Code
|
255
|
| Min. Negotiated Rate |
$1.60 |
| Max. Negotiated Rate |
$5.67 |
| Rate for Payer: Blue Shield of California Commercial |
$4.75
|
| Rate for Payer: Blue Shield of California EPN |
$3.42
|
| Rate for Payer: Cash Price |
$3.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.67
|
| Rate for Payer: Galaxy Health WC |
$5.67
|
| Rate for Payer: Global Benefits Group Commercial |
$4.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.60
|
| Rate for Payer: Multiplan Commercial |
$5.34
|
| Rate for Payer: Networks By Design Commercial |
$4.34
|
| Rate for Payer: Prime Health Services Commercial |
$5.67
|
|
|
GADODIAMIDE 7.5 MMOL/15 ML (287 MG/ML) INTRAVENOUS SOLUTION [119867]
|
Facility
OP
|
$6.67
|
|
|
Service Code
|
CPT A9579
|
| Hospital Charge Code |
NDG119867
|
|
Hospital Revenue Code
|
255
|
| Min. Negotiated Rate |
$1.60 |
| Max. Negotiated Rate |
$7.64 |
| Rate for Payer: Vantage Medical Group Senior |
$5.67
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5.67
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3.67
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.64
|
| Rate for Payer: BCBS Transplant Transplant |
$4.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4.92
|
| Rate for Payer: Blue Shield of California EPN |
$3.90
|
| Rate for Payer: Cash Price |
$3.00
|
| Rate for Payer: Cash Price |
$3.00
|
| Rate for Payer: Cigna of CA HMO |
$4.27
|
| Rate for Payer: Cigna of CA PPO |
$4.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.67
|
| Rate for Payer: Dignity Health Media |
$5.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.67
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.67
|
| Rate for Payer: Galaxy Health WC |
$5.67
|
| Rate for Payer: Global Benefits Group Commercial |
$4.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$5.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.60
|
| Rate for Payer: Multiplan Commercial |
$5.34
|
| Rate for Payer: Networks By Design Commercial |
$4.34
|
| Rate for Payer: Prime Health Services Commercial |
$5.67
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$4.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.34
|
| Rate for Payer: United Healthcare All Other HMO |
$3.34
|
| Rate for Payer: United Healthcare HMO Rider |
$3.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.67
|
|
|
GADOPICLENOL 0.5 MMOL/ML INTRAVENOUS SOLUTION [236211]
|
Facility
IP
|
$13.56
|
|
|
Service Code
|
CPT A9573
|
| Hospital Charge Code |
NDG236211A
|
|
Hospital Revenue Code
|
254
|
| Min. Negotiated Rate |
$3.25 |
| Max. Negotiated Rate |
$11.53 |
| Rate for Payer: Blue Shield of California Commercial |
$9.65
|
| Rate for Payer: Blue Shield of California EPN |
$6.94
|
| Rate for Payer: Cash Price |
$6.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.42
|
| Rate for Payer: Galaxy Health WC |
$11.53
|
| Rate for Payer: Global Benefits Group Commercial |
$8.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.25
|
| Rate for Payer: Multiplan Commercial |
$10.85
|
| Rate for Payer: Networks By Design Commercial |
$8.81
|
| Rate for Payer: Prime Health Services Commercial |
$11.53
|
|
|
GADOPICLENOL 0.5 MMOL/ML INTRAVENOUS SOLUTION [236211]
|
Facility
IP
|
$13.40
|
|
|
Service Code
|
CPT A9573
|
| Hospital Charge Code |
NDG236211C
|
|
Hospital Revenue Code
|
254
|
| Min. Negotiated Rate |
$3.22 |
| Max. Negotiated Rate |
$11.39 |
| Rate for Payer: Blue Shield of California Commercial |
$9.54
|
| Rate for Payer: Blue Shield of California EPN |
$6.86
|
| Rate for Payer: Cash Price |
$6.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.36
|
| Rate for Payer: Galaxy Health WC |
$11.39
|
| Rate for Payer: Global Benefits Group Commercial |
$8.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.22
|
| Rate for Payer: Multiplan Commercial |
$10.72
|
| Rate for Payer: Networks By Design Commercial |
$8.71
|
| Rate for Payer: Prime Health Services Commercial |
$11.39
|
|
|
GADOPICLENOL 0.5 MMOL/ML INTRAVENOUS SOLUTION [236211]
|
Facility
OP
|
$13.56
|
|
|
Service Code
|
CPT A9573
|
| Hospital Charge Code |
NDG236211A
|
|
Hospital Revenue Code
|
254
|
| Min. Negotiated Rate |
$3.25 |
| Max. Negotiated Rate |
$76.47 |
| Rate for Payer: Aetna of CA HMO/PPO |
$76.47
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$11.53
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$7.46
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$7.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8.08
|
| Rate for Payer: BCBS Transplant Transplant |
$8.14
|
| Rate for Payer: Blue Shield of California Commercial |
$9.99
|
| Rate for Payer: Blue Shield of California EPN |
$7.92
|
| Rate for Payer: Cash Price |
$6.10
|
| Rate for Payer: Cash Price |
$6.10
|
| Rate for Payer: Cigna of CA HMO |
$8.68
|
| Rate for Payer: Cigna of CA PPO |
$10.03
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.53
|
| Rate for Payer: Dignity Health Media |
$11.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.42
|
| Rate for Payer: EPIC Health Plan Transplant |
$5.42
|
| Rate for Payer: Galaxy Health WC |
$11.53
|
| Rate for Payer: Global Benefits Group Commercial |
$8.14
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$10.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.25
|
| Rate for Payer: Multiplan Commercial |
$10.85
|
| Rate for Payer: Networks By Design Commercial |
$8.81
|
| Rate for Payer: Prime Health Services Commercial |
$11.53
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$8.14
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8.14
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8.14
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.78
|
| Rate for Payer: United Healthcare All Other HMO |
$6.78
|
| Rate for Payer: United Healthcare HMO Rider |
$6.78
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.53
|
| Rate for Payer: Vantage Medical Group Senior |
$11.53
|
|
|
GADOPICLENOL 0.5 MMOL/ML INTRAVENOUS SOLUTION [236211]
|
Facility
OP
|
$13.40
|
|
|
Service Code
|
CPT A9573
|
| Hospital Charge Code |
NDG236211C
|
|
Hospital Revenue Code
|
254
|
| Min. Negotiated Rate |
$3.22 |
| Max. Negotiated Rate |
$76.47 |
| Rate for Payer: Aetna of CA HMO/PPO |
$76.47
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$11.39
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$7.37
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$7.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.98
|
| Rate for Payer: BCBS Transplant Transplant |
$8.04
|
| Rate for Payer: Blue Shield of California Commercial |
$9.88
|
| Rate for Payer: Blue Shield of California EPN |
$7.83
|
| Rate for Payer: Cash Price |
$6.03
|
| Rate for Payer: Cash Price |
$6.03
|
| Rate for Payer: Cigna of CA HMO |
$8.58
|
| Rate for Payer: Cigna of CA PPO |
$9.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.39
|
| Rate for Payer: Dignity Health Media |
$11.39
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.36
|
| Rate for Payer: EPIC Health Plan Transplant |
$5.36
|
| Rate for Payer: Galaxy Health WC |
$11.39
|
| Rate for Payer: Global Benefits Group Commercial |
$8.04
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$10.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.22
|
| Rate for Payer: Multiplan Commercial |
$10.72
|
| Rate for Payer: Networks By Design Commercial |
$8.71
|
| Rate for Payer: Prime Health Services Commercial |
$11.39
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$8.04
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8.04
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8.04
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.70
|
| Rate for Payer: United Healthcare All Other HMO |
$6.70
|
| Rate for Payer: United Healthcare HMO Rider |
$6.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.39
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.39
|
| Rate for Payer: Vantage Medical Group Senior |
$11.39
|
|
|
GADOPICLENOL 0.5 MMOL/ML INTRAVENOUS SOLUTION [236211]
|
Facility
IP
|
$13.46
|
|
|
Service Code
|
CPT A9573
|
| Hospital Charge Code |
NDG236211B
|
|
Hospital Revenue Code
|
254
|
| Min. Negotiated Rate |
$3.23 |
| Max. Negotiated Rate |
$11.44 |
| Rate for Payer: Blue Shield of California Commercial |
$9.58
|
| Rate for Payer: Blue Shield of California EPN |
$6.89
|
| Rate for Payer: Cash Price |
$6.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.38
|
| Rate for Payer: Galaxy Health WC |
$11.44
|
| Rate for Payer: Global Benefits Group Commercial |
$8.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.23
|
| Rate for Payer: Multiplan Commercial |
$10.77
|
| Rate for Payer: Networks By Design Commercial |
$8.75
|
| Rate for Payer: Prime Health Services Commercial |
$11.44
|
|
|
GADOPICLENOL 0.5 MMOL/ML INTRAVENOUS SOLUTION [236211]
|
Facility
OP
|
$13.46
|
|
|
Service Code
|
CPT A9573
|
| Hospital Charge Code |
NDG236211B
|
|
Hospital Revenue Code
|
254
|
| Min. Negotiated Rate |
$3.23 |
| Max. Negotiated Rate |
$76.47 |
| Rate for Payer: Aetna of CA HMO/PPO |
$76.47
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$11.44
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$7.40
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$7.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8.02
|
| Rate for Payer: BCBS Transplant Transplant |
$8.08
|
| Rate for Payer: Blue Shield of California Commercial |
$9.92
|
| Rate for Payer: Blue Shield of California EPN |
$7.86
|
| Rate for Payer: Cash Price |
$6.06
|
| Rate for Payer: Cash Price |
$6.06
|
| Rate for Payer: Cigna of CA HMO |
$8.61
|
| Rate for Payer: Cigna of CA PPO |
$9.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.44
|
| Rate for Payer: Dignity Health Media |
$11.44
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.38
|
| Rate for Payer: EPIC Health Plan Transplant |
$5.38
|
| Rate for Payer: Galaxy Health WC |
$11.44
|
| Rate for Payer: Global Benefits Group Commercial |
$8.08
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$10.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.23
|
| Rate for Payer: Multiplan Commercial |
$10.77
|
| Rate for Payer: Networks By Design Commercial |
$8.75
|
| Rate for Payer: Prime Health Services Commercial |
$11.44
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$8.08
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8.08
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8.08
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.73
|
| Rate for Payer: United Healthcare All Other HMO |
$6.73
|
| Rate for Payer: United Healthcare HMO Rider |
$6.73
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.73
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.44
|
| Rate for Payer: Vantage Medical Group Senior |
$11.44
|
|
|
GADOTERATE MEGLUMINE 0.5 MMOL/ML (376.9 MG/ML) INTRAVENOUS SOLUTION [201457]
|
Facility
OP
|
$6.04
|
|
|
Service Code
|
CPT A9575
|
| Hospital Charge Code |
NDG201457
|
|
Hospital Revenue Code
|
255
|
| Min. Negotiated Rate |
$1.01 |
| Max. Negotiated Rate |
$5.13 |
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5.13
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3.32
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.01
|
| Rate for Payer: BCBS Transplant Transplant |
$3.62
|
| Rate for Payer: Blue Shield of California Commercial |
$4.45
|
| Rate for Payer: Blue Shield of California EPN |
$3.53
|
| Rate for Payer: Cash Price |
$2.72
|
| Rate for Payer: Cash Price |
$2.72
|
| Rate for Payer: Cigna of CA HMO |
$3.87
|
| Rate for Payer: Cigna of CA PPO |
$4.47
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.13
|
| Rate for Payer: Dignity Health Media |
$5.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.42
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.42
|
| Rate for Payer: Galaxy Health WC |
$5.13
|
| Rate for Payer: Global Benefits Group Commercial |
$3.62
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$4.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.45
|
| Rate for Payer: Multiplan Commercial |
$4.83
|
| Rate for Payer: Networks By Design Commercial |
$3.93
|
| Rate for Payer: Prime Health Services Commercial |
$5.13
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$3.62
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.62
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.62
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.02
|
| Rate for Payer: United Healthcare All Other HMO |
$3.02
|
| Rate for Payer: United Healthcare HMO Rider |
$3.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.13
|
| Rate for Payer: Vantage Medical Group Senior |
$5.13
|
|
|
GADOTERATE MEGLUMINE 0.5 MMOL/ML (376.9 MG/ML) INTRAVENOUS SOLUTION [201457]
|
Facility
IP
|
$6.04
|
|
|
Service Code
|
CPT A9575
|
| Hospital Charge Code |
NDG201457
|
|
Hospital Revenue Code
|
255
|
| Min. Negotiated Rate |
$1.45 |
| Max. Negotiated Rate |
$5.13 |
| Rate for Payer: Blue Shield of California Commercial |
$4.30
|
| Rate for Payer: Blue Shield of California EPN |
$3.09
|
| Rate for Payer: Cash Price |
$2.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.42
|
| Rate for Payer: Galaxy Health WC |
$5.13
|
| Rate for Payer: Global Benefits Group Commercial |
$3.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.45
|
| Rate for Payer: Multiplan Commercial |
$4.83
|
| Rate for Payer: Networks By Design Commercial |
$3.93
|
| Rate for Payer: Prime Health Services Commercial |
$5.13
|
|
|
GADOTERATE MEGLUMINE 0.5 MMOL/ML INTRAVENOUS SYRINGE [203433]
|
Facility
IP
|
$6.52
|
|
|
Service Code
|
CPT A9575
|
| Hospital Charge Code |
NDG203433
|
|
Hospital Revenue Code
|
255
|
| Min. Negotiated Rate |
$1.56 |
| Max. Negotiated Rate |
$5.54 |
| Rate for Payer: Blue Shield of California Commercial |
$4.64
|
| Rate for Payer: Blue Shield of California EPN |
$3.34
|
| Rate for Payer: Cash Price |
$2.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.61
|
| Rate for Payer: Galaxy Health WC |
$5.54
|
| Rate for Payer: Global Benefits Group Commercial |
$3.91
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.56
|
| Rate for Payer: Multiplan Commercial |
$5.22
|
| Rate for Payer: Networks By Design Commercial |
$4.24
|
| Rate for Payer: Prime Health Services Commercial |
$5.54
|
|
|
GADOTERATE MEGLUMINE 0.5 MMOL/ML INTRAVENOUS SYRINGE [203433]
|
Facility
OP
|
$6.52
|
|
|
Service Code
|
CPT A9575
|
| Hospital Charge Code |
NDG203433
|
|
Hospital Revenue Code
|
255
|
| Min. Negotiated Rate |
$1.01 |
| Max. Negotiated Rate |
$5.54 |
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5.54
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3.59
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.01
|
| Rate for Payer: BCBS Transplant Transplant |
$3.91
|
| Rate for Payer: Blue Shield of California Commercial |
$4.81
|
| Rate for Payer: Blue Shield of California EPN |
$3.81
|
| Rate for Payer: Cash Price |
$2.93
|
| Rate for Payer: Cash Price |
$2.93
|
| Rate for Payer: Cigna of CA HMO |
$4.17
|
| Rate for Payer: Cigna of CA PPO |
$4.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.54
|
| Rate for Payer: Dignity Health Media |
$5.54
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.61
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.61
|
| Rate for Payer: Galaxy Health WC |
$5.54
|
| Rate for Payer: Global Benefits Group Commercial |
$3.91
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$4.89
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.56
|
| Rate for Payer: Multiplan Commercial |
$5.22
|
| Rate for Payer: Networks By Design Commercial |
$4.24
|
| Rate for Payer: Prime Health Services Commercial |
$5.54
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$3.91
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.91
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.91
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.26
|
| Rate for Payer: United Healthcare All Other HMO |
$3.26
|
| Rate for Payer: United Healthcare HMO Rider |
$3.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.54
|
| Rate for Payer: Vantage Medical Group Senior |
$5.54
|
|
|
GADOXETATE 0.25 MMOL/ML (181.43 MG/ML) INTRAVENOUS SOLUTION [93574]
|
Facility
OP
|
$17.04
|
|
|
Service Code
|
CPT A9581
|
| Hospital Charge Code |
NDG93574
|
|
Hospital Revenue Code
|
255
|
| Min. Negotiated Rate |
$4.09 |
| Max. Negotiated Rate |
$28.02 |
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$14.48
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$9.37
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$9.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$27.71
|
| Rate for Payer: BCBS Transplant Transplant |
$10.22
|
| Rate for Payer: Blue Shield of California Commercial |
$12.56
|
| Rate for Payer: Blue Shield of California EPN |
$9.95
|
| Rate for Payer: Cash Price |
$7.67
|
| Rate for Payer: Cash Price |
$7.67
|
| Rate for Payer: Cigna of CA HMO |
$10.91
|
| Rate for Payer: Cigna of CA PPO |
$12.61
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14.48
|
| Rate for Payer: Dignity Health Media |
$14.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.82
|
| Rate for Payer: EPIC Health Plan Transplant |
$6.82
|
| Rate for Payer: Galaxy Health WC |
$14.48
|
| Rate for Payer: Global Benefits Group Commercial |
$10.22
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$12.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$28.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.09
|
| Rate for Payer: Multiplan Commercial |
$13.63
|
| Rate for Payer: Networks By Design Commercial |
$11.08
|
| Rate for Payer: Prime Health Services Commercial |
$14.48
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$10.22
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10.22
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10.22
|
| Rate for Payer: United Healthcare All Other Commercial |
$8.52
|
| Rate for Payer: United Healthcare All Other HMO |
$8.52
|
| Rate for Payer: United Healthcare HMO Rider |
$8.52
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.52
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$14.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.48
|
| Rate for Payer: Vantage Medical Group Senior |
$14.48
|
|
