St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

GADAVIST

Facility

$34.00

Service Code	HCPCS A9585
Hospital Charge Code	41647843
Hospital Revenue Code	254
Min. Negotiated Rate	$0.35
Max. Negotiated Rate	$27.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$18.70
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.38
Rate for Payer: Aetna Government	$0.38
Rate for Payer: Brighton Health Commercial	$25.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$27.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$23.12
Rate for Payer: Group Health Inc Commercial	$17.00
Rate for Payer: Group Health Inc Medicare	$11.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$17.00
Rate for Payer: Hamaspik Choice Inc Medicare	$17.00
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$0.35
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$0.37
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$0.37
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$0.37
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$22.10

GADAVIST

Facility

$34.00

Service Code	HCPCS A9585
Hospital Charge Code	41657843
Hospital Revenue Code	254
Min. Negotiated Rate	$0.35
Max. Negotiated Rate	$27.20
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$18.70
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.38
Rate for Payer: Aetna Government	$0.38
Rate for Payer: Brighton Health Commercial	$25.50
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$27.20
Rate for Payer: Cigna LocalPlus Benefit Plan	$23.12
Rate for Payer: Group Health Inc Commercial	$17.00
Rate for Payer: Group Health Inc Medicare	$11.90
Rate for Payer: Hamaspik Choice Inc Medicaid	$17.00
Rate for Payer: Hamaspik Choice Inc Medicare	$17.00
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$0.35
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$0.37
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$0.37
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$0.37
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$22.10

GADOBUTROL 10 MMOL/10ML IV SOSY [183794]

Facility

$10.68

Service Code	HCPCS A9579
Hospital Charge Code	50419032528
Hospital Revenue Code	278
Min. Negotiated Rate	$5.34
Max. Negotiated Rate	$5.34
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.34
Rate for Payer: Hamaspik Choice Inc Medicare	$5.34

GADOBUTROL 10 MMOL/10ML IV SOSY [183794]

Facility

$10.68

Service Code	HCPCS A9579
Hospital Charge Code	50419032528
Hospital Revenue Code	278
Min. Negotiated Rate	$1.56
Max. Negotiated Rate	$11.21
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5.87
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.56
Rate for Payer: Aetna Government	$1.56
Rate for Payer: Brighton Health Commercial	$6.41
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$5.34
Rate for Payer: Cigna LocalPlus Benefit Plan	$6.14
Rate for Payer: EmblemHealth Commercial	$5.34
Rate for Payer: Fidelis Medicare Advantage	$11.21
Rate for Payer: Group Health Inc Commercial	$5.34
Rate for Payer: Group Health Inc Medicare	$3.74
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.34
Rate for Payer: Hamaspik Choice Inc Medicare	$5.34
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$6.94

GADODIAMIDE 287MG/ML, 10ML

Facility

$3.03

Service Code	HCPCS A9579
Hospital Charge Code	41647901
Hospital Revenue Code	254
Min. Negotiated Rate	$1.06
Max. Negotiated Rate	$2.42
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.67
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.56
Rate for Payer: Aetna Government	$1.56
Rate for Payer: Brighton Health Commercial	$2.27
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.42
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.06
Rate for Payer: Group Health Inc Commercial	$1.52
Rate for Payer: Group Health Inc Medicare	$1.06
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.52
Rate for Payer: Hamaspik Choice Inc Medicare	$1.52
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$1.51
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$1.60
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$1.60
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$1.60
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.97

GADODIAMIDE 287MG/ML, 10ML

Facility

$3.03

Service Code	HCPCS A9579
Hospital Charge Code	41657901
Hospital Revenue Code	254
Min. Negotiated Rate	$1.06
Max. Negotiated Rate	$2.42
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.67
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.56
Rate for Payer: Aetna Government	$1.56
Rate for Payer: Brighton Health Commercial	$2.27
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.42
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.06
Rate for Payer: Group Health Inc Commercial	$1.52
Rate for Payer: Group Health Inc Medicare	$1.06
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.52
Rate for Payer: Hamaspik Choice Inc Medicare	$1.52
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$1.51
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$1.60
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$1.60
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$1.60
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.97

GADODIAMIDE 287MG/ML, 15ML

Facility

$3.03

Service Code	HCPCS A9579
Hospital Charge Code	41647899
Hospital Revenue Code	254
Min. Negotiated Rate	$1.06
Max. Negotiated Rate	$2.42
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.67
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.56
Rate for Payer: Aetna Government	$1.56
Rate for Payer: Brighton Health Commercial	$2.27
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.42
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.06
Rate for Payer: Group Health Inc Commercial	$1.52
Rate for Payer: Group Health Inc Medicare	$1.06
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.52
Rate for Payer: Hamaspik Choice Inc Medicare	$1.52
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$1.51
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$1.60
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$1.60
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$1.60
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.97

GADODIAMIDE 287MG/ML, 15ML

Facility

$3.03

Service Code	HCPCS A9579
Hospital Charge Code	41657899
Hospital Revenue Code	254
Min. Negotiated Rate	$1.06
Max. Negotiated Rate	$2.42
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.67
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.56
Rate for Payer: Aetna Government	$1.56
Rate for Payer: Brighton Health Commercial	$2.27
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.42
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.06
Rate for Payer: Group Health Inc Commercial	$1.52
Rate for Payer: Group Health Inc Medicare	$1.06
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.52
Rate for Payer: Hamaspik Choice Inc Medicare	$1.52
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$1.51
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$1.60
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$1.60
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$1.60
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.97

GADODIAMIDE 287MG/ML, 20ML

Facility

$3.03

Service Code	HCPCS A9579
Hospital Charge Code	41657903
Hospital Revenue Code	254
Min. Negotiated Rate	$1.06
Max. Negotiated Rate	$2.42
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.67
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.56
Rate for Payer: Aetna Government	$1.56
Rate for Payer: Brighton Health Commercial	$2.27
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.42
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.06
Rate for Payer: Group Health Inc Commercial	$1.52
Rate for Payer: Group Health Inc Medicare	$1.06
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.52
Rate for Payer: Hamaspik Choice Inc Medicare	$1.52
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$1.51
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$1.60
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$1.60
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$1.60
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.97

GADODIAMIDE 287MG/ML, 20ML

Facility

$3.03

Service Code	HCPCS A9579
Hospital Charge Code	41647903
Hospital Revenue Code	254
Min. Negotiated Rate	$1.06
Max. Negotiated Rate	$2.42
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.67
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.56
Rate for Payer: Aetna Government	$1.56
Rate for Payer: Brighton Health Commercial	$2.27
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.42
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.06
Rate for Payer: Group Health Inc Commercial	$1.52
Rate for Payer: Group Health Inc Medicare	$1.06
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.52
Rate for Payer: Hamaspik Choice Inc Medicare	$1.52
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$1.51
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$1.60
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$1.60
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$1.60
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.97

GADODIAMIDE 287MG/ML, 5ML

Facility

$3.03

Service Code	HCPCS A9579
Hospital Charge Code	41647897
Hospital Revenue Code	254
Min. Negotiated Rate	$1.06
Max. Negotiated Rate	$2.42
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.67
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.56
Rate for Payer: Aetna Government	$1.56
Rate for Payer: Brighton Health Commercial	$2.27
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.42
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.06
Rate for Payer: Group Health Inc Commercial	$1.52
Rate for Payer: Group Health Inc Medicare	$1.06
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.52
Rate for Payer: Hamaspik Choice Inc Medicare	$1.52
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$1.51
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$1.60
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$1.60
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$1.60
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.97

GADODIAMIDE 287MG/ML, 5ML

Facility

$3.03

Service Code	HCPCS A9579
Hospital Charge Code	41657897
Hospital Revenue Code	254
Min. Negotiated Rate	$1.06
Max. Negotiated Rate	$2.42
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1.67
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.56
Rate for Payer: Aetna Government	$1.56
Rate for Payer: Brighton Health Commercial	$2.27
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$2.42
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.06
Rate for Payer: Group Health Inc Commercial	$1.52
Rate for Payer: Group Health Inc Medicare	$1.06
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.52
Rate for Payer: Hamaspik Choice Inc Medicare	$1.52
Rate for Payer: MetroPlus Health CHP/HARP/HIV SNP/Medicaid	$1.51
Rate for Payer: MetroPlus Health Commercial/Exchange/Gold Care/Medicare Advantage	$1.60
Rate for Payer: MetroPlus Health Essential Plan 1 (Non-Aliessa)/Essential Plan 2 (Non-Aliessa)	$1.60
Rate for Payer: MetroPlus Health Essential Plan 3 (Aliessa)/Essential Plan 4 (Aliessa)	$1.60
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.97

GADOPENTETATE 46.9% 10ML INJ-1ML

Facility

$3.74

Service Code	HCPCS A9579
Hospital Charge Code	41649586
Hospital Revenue Code	636
Min. Negotiated Rate	$1.31
Max. Negotiated Rate	$2.43
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.06
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.56
Rate for Payer: Aetna Government	$1.56
Rate for Payer: Brighton Health Commercial	$2.24
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.87
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.15
Rate for Payer: Group Health Inc Commercial	$1.87
Rate for Payer: Group Health Inc Medicare	$1.31
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.87
Rate for Payer: Hamaspik Choice Inc Medicare	$1.87
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1.60
Rate for Payer: SOMOS Essential	$1.60
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.43

GADOPENTETATE 46.9% 10ML INJ-1ML

Facility

$3.74

Service Code	HCPCS A9579
Hospital Charge Code	41649586
Hospital Revenue Code	636
Min. Negotiated Rate	$1.87
Max. Negotiated Rate	$1.87
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.87
Rate for Payer: Hamaspik Choice Inc Medicare	$1.87

GADOPENTETATE 46.9% 10ML INJ-1ML

Facility

$3.74

Service Code	HCPCS A9579
Hospital Charge Code	41659586
Hospital Revenue Code	636
Min. Negotiated Rate	$1.31
Max. Negotiated Rate	$2.43
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.06
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.56
Rate for Payer: Aetna Government	$1.56
Rate for Payer: Brighton Health Commercial	$2.24
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.87
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.15
Rate for Payer: Group Health Inc Commercial	$1.87
Rate for Payer: Group Health Inc Medicare	$1.31
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.87
Rate for Payer: Hamaspik Choice Inc Medicare	$1.87
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1.60
Rate for Payer: SOMOS Essential	$1.60
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.43

GADOPENTETATE 46.9% 10ML INJ-1ML

Facility

$3.74

Service Code	HCPCS A9579
Hospital Charge Code	41659586
Hospital Revenue Code	636
Min. Negotiated Rate	$1.87
Max. Negotiated Rate	$1.87
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.87
Rate for Payer: Hamaspik Choice Inc Medicare	$1.87

GADOPENTETATE 46.9% 15ML INJ-1ML

Facility

$3.74

Service Code	HCPCS A9579
Hospital Charge Code	41659585
Hospital Revenue Code	636
Min. Negotiated Rate	$1.87
Max. Negotiated Rate	$1.87
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.87
Rate for Payer: Hamaspik Choice Inc Medicare	$1.87

GADOPENTETATE 46.9% 15ML INJ-1ML

Facility

$3.74

Service Code	HCPCS A9579
Hospital Charge Code	41659585
Hospital Revenue Code	636
Min. Negotiated Rate	$1.31
Max. Negotiated Rate	$2.43
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.06
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.56
Rate for Payer: Aetna Government	$1.56
Rate for Payer: Brighton Health Commercial	$2.24
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.87
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.15
Rate for Payer: Group Health Inc Commercial	$1.87
Rate for Payer: Group Health Inc Medicare	$1.31
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.87
Rate for Payer: Hamaspik Choice Inc Medicare	$1.87
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1.60
Rate for Payer: SOMOS Essential	$1.60
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.43

GADOPENTETATE 46.9% 15ML INJ-1ML

Facility

$3.74

Service Code	HCPCS A9579
Hospital Charge Code	41649585
Hospital Revenue Code	636
Min. Negotiated Rate	$1.31
Max. Negotiated Rate	$2.43
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.06
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.56
Rate for Payer: Aetna Government	$1.56
Rate for Payer: Brighton Health Commercial	$2.24
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.87
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.15
Rate for Payer: Group Health Inc Commercial	$1.87
Rate for Payer: Group Health Inc Medicare	$1.31
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.87
Rate for Payer: Hamaspik Choice Inc Medicare	$1.87
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1.60
Rate for Payer: SOMOS Essential	$1.60
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.43

GADOPENTETATE 46.9% 15ML INJ-1ML

Facility

$3.74

Service Code	HCPCS A9579
Hospital Charge Code	41649585
Hospital Revenue Code	636
Min. Negotiated Rate	$1.87
Max. Negotiated Rate	$1.87
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.87
Rate for Payer: Hamaspik Choice Inc Medicare	$1.87

GADOPENTETATE 46.9% 20ML INJ-1ML

Facility

$3.74

Service Code	HCPCS A9579
Hospital Charge Code	41659584
Hospital Revenue Code	636
Min. Negotiated Rate	$1.31
Max. Negotiated Rate	$2.43
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.06
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.56
Rate for Payer: Aetna Government	$1.56
Rate for Payer: Brighton Health Commercial	$2.24
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.87
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.15
Rate for Payer: Group Health Inc Commercial	$1.87
Rate for Payer: Group Health Inc Medicare	$1.31
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.87
Rate for Payer: Hamaspik Choice Inc Medicare	$1.87
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1.60
Rate for Payer: SOMOS Essential	$1.60
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.43

GADOPENTETATE 46.9% 20ML INJ-1ML

Facility

$3.74

Service Code	HCPCS A9579
Hospital Charge Code	41649584
Hospital Revenue Code	636
Min. Negotiated Rate	$1.31
Max. Negotiated Rate	$2.43
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$2.06
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1.56
Rate for Payer: Aetna Government	$1.56
Rate for Payer: Brighton Health Commercial	$2.24
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.87
Rate for Payer: Cigna LocalPlus Benefit Plan	$2.15
Rate for Payer: Group Health Inc Commercial	$1.87
Rate for Payer: Group Health Inc Medicare	$1.31
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.87
Rate for Payer: Hamaspik Choice Inc Medicare	$1.87
Rate for Payer: SOMOS CHP/HARP/Medicaid	$1.60
Rate for Payer: SOMOS Essential	$1.60
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$2.43

GADOPENTETATE 46.9% 20ML INJ-1ML

Facility

$3.74

Service Code	HCPCS A9579
Hospital Charge Code	41649584
Hospital Revenue Code	636
Min. Negotiated Rate	$1.87
Max. Negotiated Rate	$1.87
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.87
Rate for Payer: Hamaspik Choice Inc Medicare	$1.87

GADOPENTETATE 46.9% 20ML INJ-1ML

Facility

$3.74

Service Code	HCPCS A9579
Hospital Charge Code	41659584
Hospital Revenue Code	636
Min. Negotiated Rate	$1.87
Max. Negotiated Rate	$1.87
Rate for Payer: Hamaspik Choice Inc Medicaid	$1.87
Rate for Payer: Hamaspik Choice Inc Medicare	$1.87

GADOXETATE DISODIUM 0.25 MMOL/ML IV SOLN [93574]

Facility

$17.04

Service Code	HCPCS A9581
Hospital Charge Code	50419032005
Hospital Revenue Code	278
Min. Negotiated Rate	$8.52
Max. Negotiated Rate	$8.52
Rate for Payer: Hamaspik Choice Inc Medicaid	$8.52
Rate for Payer: Hamaspik Choice Inc Medicare	$8.52

Know your out-of-pocket cost for care.

All Charges