Inj gadopiclenol 1 ml

Reported by 57 hospitals in the network under the fee schedule methodology.

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Reflects negotiated fee schedule rates with commercial payers.

National pricing summary

Low

Average

Median

High

$14

#	Hospital	Location
1	IHC Health Services Inc., DBA Intermountain Health Intermountain Medical Center	Murray, UT	$5	$5	—	—	$5	$5
2	IHC Health Services Inc., DBA Intermountain Health Utah Valley Hospital	Provo, UT	$5	$5	—	—	$5	$5
3	IHC Health Services Inc., DBA Intermountain Health McKay-Dee Hospital	Ogden, UT	$5	$5	—	—	$5	$5
4	IHC Health Services Inc., DBA Intermountain Health St George Regional Hospital	St. George, UT	$5	$5	—	—	$5	$5
5	IHC Health Services Inc., DBA Intermountain Health LDS Hospital	Salt Lake City, UT	$5	$5	—	—	$5	$5
6	Scl Health - Montana, Dba Intermountain Health St. Vincent Healthcare	Billings, MT	$13	$13	—	—	$13	$13
7	Saint Joseph Hospital, Inc. Dba Intermountain Nhealth Saint Joseph Hospital	DENVER, CO	$4	$7	$4	—	$4	$14
8	IHC Health Services Inc., DBA Intermountain Health Logan Regional Hospital	Logan, UT	$5	$5	—	—	$5	$5
9	St. Mary's Hospital & Medical Center, Inc. Dba Intermountain Health St. Mary's Regional Hospital	JUNCTION, CO	$8	$9	$2	—	$8	$14
10	IHC Health Services Inc., DBA Intermountain Health American Fork Hospital	American Fork, UT	$5	$5	—	—	$5	$5

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