Technetium-99m disofenin diagnostic imaging agent

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.

Model: claude-haiku-5-5
Provider: anthropic
API: message_batches
Reasoning effort: low
Max output tokens: 4096
Prompt version (hash): 444523875572
Generated: October 20, 2026

Original text from hospital filings

TC99M DISOFENIN PER STUDY DOSE =< 15 MCI ; X1 MAX [NM]

Payers reporting HCPCS A9510

Payer pricing summary

Low

$43

Average

$251

Median

$224

High

$1.4k

Payer rate distribution

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#
1	UnitedHealthcare fee schedule · outpatient · +21 other terms	397	$102	$127	$99	78%	—	$1 – $800
2	Cigna fee schedule · outpatient · +16 other terms	215	$134	$212	$156	73%	—	$28 – $625
3	Blue Cross Blue Shield fee schedule · outpatient · +20 other terms	197	$150	$173	$152	88%	—	$0 – $2.1k
4	Aetna fee schedule · outpatient · +20 other terms	117	$142	$193	$228	118%	—	$0 – $1.3k
5	Humana fee schedule · outpatient · +16 other terms	91	$228	$394	$292	74%	—	$1 – $818
6	Anthem fee schedule · outpatient · +18 other terms	59	$0	$41	$70	169%	—	$0 – $341
7	MultiPlan fee schedule · outpatient · +11 other terms	50	$194	$192	$147	77%	—	$32 – $919
8	Kaiser fee schedule · both · +12 other terms	45	$86	$89	$25	28%	—	$36 – $131
9	Bcbs Tx fee schedule · outpatient · +4 other terms	31	$299	$273	$92	34%	—	$87 – $475
10	Medica fee schedule · outpatient · +11 other terms	21	$167	$163	$36	22%	—	$69 – $209
11	Molina facility · case rate · outpatient · +15 other terms	18	$124	$128	$27	21%	—	$82 – $199
12	First Health fee schedule · inpatient · +13 other terms	17	$226	$231	$158	69%	—	$77 – $788
13	Carefirst facility · fee schedule · both · +3 other terms	16	$87	$99	$54	54%	—	$40 – $295
14	Excellus facility · fee schedule · both · +4 other terms	16	$87	$99	$54	54%	—	$40 – $295
15	Highmark facility · fee schedule · both · +13 other terms	16	$87	$103	$56	55%	—	$40 – $295
16	Premera facility · fee schedule · both · +3 other terms	16	$87	$99	$54	54%	—	$40 – $295
17	Regence facility · fee schedule · both · +8 other terms	16	$87	$100	$55	55%	—	$40 – $295
18	Wellmark facility · fee schedule · both · +5 other terms	16	$87	$99	$54	54%	—	$40 – $295
19	Caresource facility · case rate · outpatient · +10 other terms	15	$120	$128	$29	23%	—	$80 – $203
20	Healthcare Highways percent of total billed charges · outpatientfrom % of charges	15	$231	$253	$181	72%	—	$43 – $755
21	Phcs fee schedule · outpatient · +9 other terms	15	$239	$234	$68	29%	—	$170 – $415
22	Bcbs Mn fee schedule · outpatient · +5 other terms	12	$139	$88	$77	87%	—	$0 – $174
23	WellCare professional · fee schedule · outpatient · +11 other terms	12	$43	$43	$0	1%	—	$43 – $44
24	Medicaid fee schedule · outpatient · +8 other terms	11	$367	$835	$964	115%	—	$1 – $3.2k
25	Optum facility · case rate · outpatient · +8 other terms	11	$111	$121	$27	22%	—	$100 – $180

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