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 5 ML INJ
HOUSTON, TX
See all hospitals reporting HCPCS A9575 →Price type
Hca Houston Healthcare West’s median price of $26 is 5279% above the median hospital's median price ($0), higher than 71% 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: 9 payers, 27 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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Filter by billing class
| # | ||||
|---|---|---|---|---|
| 1 | UnitedHealthcare allpayerappendix fee schedule · outpatient | $0.17 | $0.17 | $0.17 – $0.17 |
| 2 | UnitedHealthcare narrownetworkindivexchange fee schedule · outpatient | $0.17 | $0.17 | $0.17 – $0.17 |
| 3 | UnitedHealthcare smallgroup fee schedule · outpatient | $0.17 | $0.17 | $0.17 – $0.17 |
| 4 | Cigna csn fee schedule · outpatient | $0.29 | $0.29 | $0.29 – $0.29 |
| 5 | Cigna openaccessplus fee schedule · outpatient | $0.31 | $0.31 | $0.31 – $0.31 |
| 6 | Cigna ppo fee schedule · outpatient | $0.37 | $0.37 | $0.37 – $0.37 |
| 7 | Blue Cross Blue Shield mybluehealth fee schedule · outpatient | $0.39 | $0.39 | $0.39 – $0.39 |
| 8 | Blue Cross Blue Shield bav fee schedule · outpatient | $0.43 | $0.43 | $0.43 – $0.43 |
| 9 | Blue Cross Blue Shield eposoa fee schedule · outpatient | $0.54 | $0.54 | $0.54 – $0.54 |
| 10 | Blue Cross Blue Shield hmo fee schedule · outpatient | $0.54 | $0.54 | $0.54 – $0.54 |
| 11 | Blue Cross Blue Shield ppo fee schedule · outpatient | $0.54 | $0.54 | $0.54 – $0.54 |
| 12 | Humana hmo fee schedule · outpatient | $2.05 | $2.05 | $2.05 – $2.05 |
| 13 | Humana ppo fee schedule · outpatient | $2.05 | $2.05 | $2.05 – $2.05 |
| 14 | Superior Healthplan chip percent of total billed charges · outpatientfrom % of charges | $8.10 | $7.12 | $4.50 – $8.76 |
| 15 | Superior Healthplan chpfc percent of total billed charges · outpatientfrom % of charges | $8.10 | $7.12 | $4.50 – $8.76 |
| 16 | Superior Healthplan star percent of total billed charges · outpatientfrom % of charges | $8.10 | $7.12 | $4.50 – $8.76 |
| 17 | Superior Healthplan starkids percent of total billed charges · outpatientfrom % of charges | $8.10 | $7.12 | $4.50 – $8.76 |
| 18 | Superior Healthplan starplus percent of total billed charges · outpatientfrom % of charges | $8.10 | $7.12 | $4.50 – $8.76 |
| 19 | Aetna mcr percent of total billed charges · outpatientfrom % of charges | $8.95 | $7.87 | $4.97 – $9.68 |
| 20 | UnitedHealthcare optionsppo percent of total billed charges · outpatientfrom % of charges | $22.68 | $19.94 | $12.60 – $24.53 |
| 21 | Molina hix percent of total billed charges · outpatientfrom % of charges | $36.45 | $32.04 | $20.25 – $39.42 |
| 22 | Blue Cross Blue Shield traditional percent of total billed charges · outpatientfrom % of charges | $47.25 | $41.53 | $26.25 – $51.10 |
| 23 | UnitedHealthcare globalappendix percent of total billed charges · outpatientfrom % of charges | $60.75 | $53.40 | $33.75 – $65.70 |
| 24 | First Health comm percent of total billed charges · outpatientfrom % of charges | $71.95 | $63.25 | $39.98 – $77.82 |
| 25 | MultiPlan phcsprimarynetwork percent of total billed charges · outpatientfrom % of charges | $101.25 | $89.00 | $56.25 – $109.50 |
Last updated: May 14, 2026
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