HCPCS A9575

Injection, gadoterate meglumine, 0.1 ml

Current code12 hospitals with prices

Description from CMS's HCPCS Level II code file.

What Washington hospitals publish for this code

Medicaid (state program): Washington Apple Health fee-for-service. Applies only to Medicaid enrollees.

Prices for HCPCS A9575 by hospital
Hospital	Medicaid (state program) rates (lowest – highest)	Cash price	List price (before discounts)
Cascade Medical CenterLeavenworth	$77.451 plan	$116	$145
EvergreenHealth Medical CenterKirkland	—	$96.00 – $195	$120 – $244
EvergreenHealth MonroeMonroe	—	$106 – $107	$132 – $134
Providence Regional Medical Center EverettEverettFile dated 2026-04-01	—	$46.80	$90.00
Seattle Children's HospitalSeattle	$168 – $2901 plan	$666 – $1,150	$666 – $1,150
Swedish Edmonds HospitalEdmondsFile dated 2026-04-01	—	$43.20	$90.00
WhidbeyHealth Medical CenterCoupeville	—	$140	$140

Lowest and highest amounts each hospital lists for this code as an outpatient, including lines it lists for both settings or without saying which. A doctor’s fee is shown separately when the hospital lists one with the code. “At least” means plans were counted in more than one group and some may be the same plan. This is one line of a bill; most care brings several.

Medicare (traditional) reference

CMS publishes no national amount for this code.