HCPCS A9576
Injection, gadoteridol, (prohance multipack), per ml
Current code17 hospitals with prices
What Washington hospitals publish for this code
Medicaid (state program): Washington Apple Health fee-for-service. Applies only to Medicaid enrollees.
| Hospital | Medicaid (state program) rates (lowest – highest) | Cash price | List price (before discounts) |
|---|---|---|---|
| Cascade Medical Center | $112 – $185 | $168 – $277 | $209 – $347 |
| Island Hospital | — | — | — |
| Kadlec Regional Medical Center | — | — | — |
| Legacy Salmon Creek Medical Center | — | — | — |
| Overlake Hospital Medical Center & Clinics | — | — | — |
| Prov Sacred HRT Med Ctr & Childs Hosp. | — | — | — |
| Providence Centralia Hospital | — | — | — |
| Providence Holy Family Hospital | — | — | — |
| Providence Regional Medical Center Everett | — | — | — |
| Providence St Mary Medical Center | — | — | — |
| Providence St Peter Hospital | — | — | — |
| Swedish Edmonds Hospital | — | — | — |
| Swedish Issaquah | — | — | — |
| Swedish Medical Center | — | — | — |
| Swedish Medical Center / Cherry Hill | — | — | — |
| Three Rivers Hospital | $7.15 – $8.09 | $10.21 – $11.55 | $10.21 – $11.55 |
| Yakima Valley Memorial | — | — | — |
Medicare (traditional) reference
CMS publishes no national amount for this code.