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]

Medicaid pricing summary

Low

Average

$408

Median

$83

High

$3.2k

Medicaid rate distribution

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34 hospital rates

#		Plans
1	ADVENTIST HEALTH CLEARLAKE HOSPITAL INC Clearlake, CA fee schedule · outpatient	1	$367	$367	—	—	—	$367 – $367
2	ADVENTIST HEALTH DELANO Delano, CA fee schedule · outpatient	1	$55	$55	—	—	—	$55 – $55
3	ADVENTIST HEALTH TULARE Tulare, CA fee schedule · outpatient	1	$94	$94	—	—	—	$94 – $94
4	ARTHUR G JAMES CANCER HOSPITAL AND RESEARCH INSTITUTE Columbus, OH percent of total billed charges · inpatientfrom % of charges	1	$41	$41	—	—	—	$41 – $41
5	ARTHUR G JAMES CANCER HOSPITAL AND RESEARCH INSTITUTE Columbus, OH percent of total billed charges · outpatientfrom % of charges	1	$33	$33	—	—	—	$33 – $33
6	Allina Health Systems Ulm, MN facility · other · outpatient	1	$56	$56	—	—	—	$56 – $56
7	Chapman Global Medical Center Orange, CA facility · fee schedule · outpatient	1	$35	$35	—	—	—	$35 – $35
8	Chilton Medical Center Pompton Plains, NJ percent of total billed charges · bothfrom % of charges	1	$65	$65	—	—	—	$65 – $65
9	GLENDALE ADVENTIST MEDICAL CENTER Glendale, CA fee schedule · outpatient	1	$832	$832	—	—	—	$832 – $832
10	HANFORD COMMUNITY HOSPITAL Selma, CA fee schedule · outpatient	1	$94	$94	—	—	—	$94 – $94
11	Hackettstown Medical Center Hackettstown, NJ percent of total billed charges · bothfrom % of charges	1	$42	$42	—	—	—	$42 – $42
12	Hospital Authority of Colquitt County Moultrie, GA fee schedule · both	1	$210	$210	$7	3%	—	$203 – $216
13	Lowell General Hospital Lowell, MA percent of total billed charges · bothfrom % of charges	1	$993	$993	—	—	—	$993 – $993
14	MELROSEWAKEFIELD HEALTHCARE Medford, MA percent of total billed charges · bothfrom % of charges	1	$993	$993	—	—	—	$993 – $993
15	Mercy Hospital Aurora Aurora, MO facility · fee schedule · outpatient	1	$48	$48	—	—	—	$48 – $48
16	Mercy Hospital Cassville Knob, MO facility · fee schedule · outpatient	1	$48	$48	—	—	—	$48 – $48
17	Mercy Hospital Springfield Ozark, MO facility · fee schedule · outpatient	1	$48	$48	—	—	—	$48 – $48
18	Mercy Hospital Springfield Springfield, MO facility · fee schedule · outpatient	1	$48	$48	—	—	—	$48 – $48
19	Mercy Perry Perryville, MO facility · percent of total billed charges · outpatientfrom % of charges	1	$45	$45	—	—	—	$45 – $45
20	Morristown Medical Center Morristown, NJ percent of total billed charges · bothfrom % of charges	1	$74	$74	—	—	—	$74 – $74
21	Newton Medical Center Newton, NJ percent of total billed charges · bothfrom % of charges	1	$41	$41	—	—	—	$41 – $41
22	Ohio State University Hospitals Columbus, OH fee schedule · outpatient	1	$1	$1	—	—	—	$1 – $1
23	Overlook Medical Center Summit, NJ percent of total billed charges · bothfrom % of charges	1	$104	$104	—	—	—	$104 – $104
24	SAN JOAQUIN COMMUNITY HOSPITAL Bakersfield, CA fee schedule · outpatient	1	$231	$231	—	—	—	$231 – $231
25	SIERRA VISTA HOSPITAL INC Obispo, CA fee schedule · outpatient	1	$1.6k	$1.6k	—	—	—	$1.6k – $1.6k