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.
Original text from hospital filings
DOTAREM 10MMOL/20ML PFS
Hayden, KY
See all hospitals reporting HCPCS A9575 →Price type
ARH Mary Breckinridge Health Services, Inc’s median price of $92 is 19197% above the median hospital's median price ($0), higher than 85% of the 1,486 hospitals reporting HCPCS A9575. The highlighted bar is where this hospital falls; shaded is the middle 50% of hospitals.
Negotiated rates from the hospital’s own file: 8 payers, 14 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 | Anthem commercial fee schedule · outpatient | $0.14 | $0.14 | $0.14 – $0.14 |
| 2 | Aetna Better Health medicaid percent of total billed charges · outpatientfrom % of charges | $90.75 | $90.75 | $90.75 – $90.75 |
| 3 | Anthem medicaid percent of total billed charges · outpatientfrom % of charges | $90.75 | $90.75 | $90.75 – $90.75 |
| 4 | Humana medicaid percent of total billed charges · outpatientfrom % of charges | $90.75 | $90.75 | $90.75 – $90.75 |
| 5 | Anthem medicare advantage percent of total billed charges · outpatientfrom % of charges | $91.66 | $91.66 | $91.66 – $91.66 |
| 6 | Humana medicare percent of total billed charges · outpatientfrom % of charges | $91.66 | $91.66 | $91.66 – $91.66 |
| 7 | Optum veterans affairs plan percent of total billed charges · outpatientfrom % of charges | $91.66 | $91.66 | $91.66 – $91.66 |
| 8 | WellCare medicaid percent of total billed charges · outpatientfrom % of charges | $91.66 | $91.66 | $91.66 – $91.66 |
| 9 | WellCare medicare percent of total billed charges · outpatientfrom % of charges | $91.66 | $91.66 | $91.66 – $91.66 |
| 10 | Molina medicaid percent of total billed charges · outpatientfrom % of charges | $92.57 | $92.57 | $92.57 – $92.57 |
| 11 | UnitedHealthcare medicare percent of total billed charges · outpatientfrom % of charges | $114.95 | $114.95 | $114.95 – $114.95 |
| 12 | Aetna medicare percent of total billed charges · outpatientfrom % of charges | $127.05 | $127.05 | $127.05 – $127.05 |
| 13 | UnitedHealthcare commercial percent of total billed charges · outpatientfrom % of charges | $326.70 | $326.70 | $326.70 – $326.70 |
| 14 | Aetna commercial percent of total billed charges · bothfrom % of charges | $532.40 | $532.40 | $532.40 – $532.40 |
Last updated: Jan 1, 2026
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