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
TC99M DISOFENIN PER STUDY DOSE =< 15 MCI ; X1 MAX [NM]
Low
$28
Average
$361
Median
$223
High
$885
Each hospital's average Tricare rate, under the methodology and billing class chosen below.
36 hospitals; the 90th percentile is 12.5× the 10th. Each bar is a price range and its height is how many hospitals fall in it. Hover a bar, or a row in the ladder, for details.
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37 hospital rates
iThe hospitals that file a Tricare rate for this code, one row per hospital and set of terms (billing class, payment method, setting). Rates under different terms are never blended, so the terms are shown under each hospital’s name. Figures are the hospital’s averages across its plans.| # | Plans | |||||||
|---|---|---|---|---|---|---|---|---|
| 1 | Baptist Medical Center-Attala Kosciusko, MS facility · percent of total billed charges · outpatientfrom % of charges | 1 | $149 | $149 | — | — | — | $149 – $149 |
| 2 | Baptist Medical Center-Yazoo Yazoo City, MS facility · percent of total billed charges · outpatientfrom % of charges | 1 | $145 | $145 | — | — | — | $145 – $145 |
| 3 | Baptist Memorial Hospital - Leake Carthage, MS facility · percent of total billed charges · outpatientfrom % of charges | 1 | $145 | $145 | — | — | — | $145 – $145 |
| 4 | Baptist Memorial Hospital-Calhoun Calhoun City, MS facility · percent of total billed charges · outpatientfrom % of charges | 1 | $183 | $183 | — | — | — | $183 – $183 |
| 5 | CentraState Medical Center Freehold Township, NJ other · outpatient | 2 | $625 | $625 | — | — | — | $625 – $625 |
| 6 | Chilton Medical Center Pompton Plains, NJ other · outpatient | 2 | $625 | $625 | — | — | — | $625 – $625 |
| 7 | Columbia Lutheran Charities Astoria, OR facility · percent of total billed charges · bothfrom % of charges | 1 | $71 | $71 | — | — | — | $71 – $71 |
| 8 | Ellis Hospital NY 12308; 2210 Troy Schenectady Road Niskayuna, NY facility · fee schedule · outpatient | 1 | $236 | $236 | — | — | — | $236 – $236 |
| 9 | GUTHRIE CORTLAND MEDICAL CENTER Cortland, NY facility · other · outpatient | 1 | $73 | $73 | — | — | — | $73 – $73 |
| 10 | HOULTON REGIONAL HOSPITAL HOULTON, ME percent of total billed charges · bothfrom % of charges | 1 | $70 | $70 | — | — | — | $70 – $70 |
| 11 | HSA CGH LLC Coral Gables, FL facility · percent of total billed charges · outpatientfrom % of charges | 1 | $179 | $179 | — | — | — | $179 – $179 |
| 12 | Hackettstown Medical Center Hackettstown, NJ other · outpatient | 2 | $625 | $625 | — | — | — | $625 – $625 |
| 13 | Holy Cross Germantown Hospital Germantown, MD facility · percent of total billed charges · bothfrom % of charges | 1 | $359 | $359 | — | — | — | $359 – $359 |
| 14 | Holy Cross Hospital-Silver Spring Silver Spring, MD facility · percent of total billed charges · bothfrom % of charges | 1 | $362 | $362 | — | — | — | $362 – $362 |
| 15 | Hospital Authority of Colquitt County Moultrie, GA fee schedule · both | 1 | $210 | $210 | $7 | 3% | — | $203 – $216 |
| 16 | MACON COMMUNITY HOSPITAL LAFAYETTE, TN percent of total billed charges · outpatientfrom % of charges | 1 | $28 | $28 | — | — | — | $28 – $28 |
| 17 | MCLAREN THUMB REGION AXE, MI fee schedule | 1 | $433 | $433 | — | — | — | $433 – $433 |
| 18 | Mercy Hospital Aurora Aurora, MO facility · percent of total billed charges · outpatientfrom % of charges | 1 | $91 | $91 | — | — | — | $91 – $91 |
| 19 | Mercy Hospital Cassville Knob, MO facility · percent of total billed charges · outpatientfrom % of charges | 1 | $126 | $126 | — | — | — | $126 – $126 |
| 20 | Mercy Perry Perryville, MO facility · percent of total billed charges · outpatientfrom % of charges | 1 | $109 | $109 | — | — | — | $109 – $109 |
| 21 | Mid Hudson Regional Hospital Poughkeepsie, NY facility · fee schedule · outpatient | 1 | $144 | $144 | — | — | — | $144 – $144 |
| 22 | Morristown Medical Center Morristown, NJ other · outpatient | 2 | $625 | $625 | — | — | — | $625 – $625 |
| 23 | Newton Medical Center Newton, NJ other · outpatient | 2 | $625 | $625 | — | — | — | $625 – $625 |
| 24 | North Adams Regional Hospital North Adams, MA facility · fee schedule · outpatient | 1 | $60 | $60 | — | — | — | $60 – $60 |
| 25 | Northside Hospital, Inc. Lawrenceville, GA fee schedule · outpatient | 1 | $885 | $885 | — | — | — | $885 – $885 |
← Payers reporting HCPCS A9510 · Snapshot 20261111T120946Z-9134e7f7