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]

UnitedHealthcare pricing summary

Low

Average

$190

Median

$108

High

$4.2k

UnitedHealthcare rate distribution

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1,016 hospital rates

#		Plans
1	Hendrick Medical Center Abilene, TX facility · percent of total billed charges · outpatientfrom % of charges	1	$100	$100	—	—	16	$100 – $100
2	Hendrick Medical Center Abilene, TX facility · percent of total billed charges · outpatientfrom % of charges	1	$100	$100	—	—	16	$100 – $100
3	DELTA COUNTY MEMORIAL HOSPITAL DELTA, CO percent of total billed charges · outpatientfrom % of charges	1	$146	$146	—	—	1–10	$146 – $146
4	HOULTON REGIONAL HOSPITAL HOULTON, ME percent of total billed charges · bothfrom % of charges	1	$160	$160	—	—	1–10	$160 – $160
5	Hendrick Medical Center Brownwood, TX facility · percent of total billed charges · outpatientfrom % of charges	1	$94	$94	—	—	1–10	$94 – $94
6	STONEWALL JACKSON HOSPITAL Weston, WV percent of total billed charges · outpatientfrom % of charges	1	$271	$271	—	—	1–10	$271 – $271
7	St Joseph Mercy Ann Arbor Ypsilanti, MI facility · percent of total billed charges · bothfrom % of charges	2	$277	$277	$29	10%	1–10	$249 – $306
8	ADVENTIST HEALTH CLEARLAKE HOSPITAL INC Clearlake, CA fee schedule · outpatient	2	$168	$168	—	—	—	$168 – $168
9	ADVENTIST HEALTH CLEARLAKE HOSPITAL INC Clearlake, CA percent of total billed charges · outpatientfrom % of charges	1	$85	$85	—	—	—	$85 – $85
10	ADVENTIST HEALTH DELANO Delano, CA percent of total billed charges · outpatientfrom % of charges	3	$40	$39	$1	2%	—	$38 – $40
11	ADVENTIST HEALTH TULARE Tulare, CA percent of total billed charges · outpatientfrom % of charges	2	$66	$66	$2	3%	—	$65 – $68
12	AKRON GENERAL MEDICAL CENTER Akron, OH facility · case rate · outpatient	1	$114	$114	—	—	—	$114 – $114
13	AKRON GENERAL MEDICAL CENTER Akron, OH facility · fee schedule · outpatient	1	$129	$129	—	—	—	$129 – $129
14	ALEGENT CREIGHTON HEALTH Papillion, NE fee schedule · outpatient	2	$78	$78	$21	26%	—	$57 – $99
15	ALEGENT CREIGHTON HEALTH Plainview, NE fee schedule · inpatient	1	$188	$188	—	—	—	$188 – $188
16	ALEGENT CREIGHTON HEALTH Plainview, NE fee schedule · outpatient	3	$129	$146	$30	21%	—	$121 – $188
17	ALEGENT CREIGHTON HEALTH Omaha, NE fee schedule · outpatient	2	$75	$75	$24	32%	—	$51 – $99
18	ALEGENT HEALTH - MERCY HOSPITAL, CORNING IOWA Corning, IA fee schedule · inpatient	1	$194	$194	—	—	—	$194 – $194
19	ALEGENT HEALTH - MERCY HOSPITAL, CORNING IOWA Corning, IA fee schedule · outpatient	3	$85	$121	$51	42%	—	$85 – $194
20	ALEGENT HEALTH BERGAN MERCY HEALTH SYSTEM Council Bluffs, IA fee schedule · outpatient	2	$123	$123	$24	20%	—	$99 – $147
21	ALEGENT HEALTH BERGAN MERCY HEALTH SYSTEM Omaha, NE fee schedule · outpatient	2	$76	$76	$22	29%	—	$54 – $99
22	ALEGENT HEALTH BERGAN MERCY HEALTH SYSTEM Omaha, NE fee schedule · outpatient	2	$76	$76	$22	29%	—	$54 – $99
23	ALEGENT HEALTH COMMUNITY MEMORIAL HOSPITAL OF MISSOURI VALLEY, IOWA Missouri Valley, IA fee schedule · inpatient	1	$190	$190	—	—	—	$190 – $190
24	ALEGENT HEALTH COMMUNITY MEMORIAL HOSPITAL OF MISSOURI VALLEY, IOWA Missouri Valley, IA fee schedule · outpatient	3	$85	$115	$54	47%	—	$69 – $190
25	ALEGENT HEALTH IMMANUEL MEDICAL CENTER Omaha, NE fee schedule · outpatient	2	$72	$72	$27	38%	—	$45 – $99

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HCPCS A9510