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
$24
Average
$135
Median
$61
High
$625
Each hospital's average WellCare rate, under the methodology and billing class chosen below.
82 hospitals; the 90th percentile is 5.6× 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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83 hospital rates
iThe hospitals that file a WellCare 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 | HOULTON REGIONAL HOSPITAL HOULTON, ME percent of total billed charges · bothfrom % of charges | 1 | $71 | $71 | — | — | 1–10 | $71 – $71 |
| 2 | ANGEL MEDICAL CENTER Franklin, NC percent of total billed charges · outpatientfrom % of charges | 1 | $60 | $60 | — | — | — | $60 – $60 |
| 3 | Acadia Hospital Bangor, ME professional · fee schedule · outpatient | 1 | $43 | $43 | — | — | — | $43 – $43 |
| 4 | Alleghany County Memorial Hospital, Inc Sparta, NC facility · percent of total billed charges · outpatientfrom % of charges | 1 | $67 | $67 | $34 | 50% | — | $33 – $101 |
| 5 | BLUE RIDGE REGIONAL HOSPITAL Spruce Pine, NC percent of total billed charges · outpatientfrom % of charges | 1 | $56 | $56 | — | — | — | $56 – $56 |
| 6 | Baptist Medical Center-Attala Kosciusko, MS facility · percent of total billed charges · outpatientfrom % of charges | 1 | $165 | $165 | — | — | — | $165 – $165 |
| 7 | Baptist Medical Center-Yazoo Yazoo City, MS facility · percent of total billed charges · outpatientfrom % of charges | 1 | $160 | $160 | — | — | — | $160 – $160 |
| 8 | Baptist Memorial Hospital - Leake Carthage, MS facility · percent of total billed charges · outpatientfrom % of charges | 1 | $160 | $160 | — | — | — | $160 – $160 |
| 9 | Blue Hill Memorial Hospital Hill, ME professional · fee schedule · outpatient | 1 | $43 | $43 | — | — | — | $43 – $43 |
| 10 | Bristol Regional Medical Center BRISTOL, VA percent of total billed charges · bothfrom % of charges | 1 | $243 | $243 | — | — | — | $243 – $243 |
| 11 | CentraState Medical Center Freehold Township, NJ other · outpatient | 2 | $625 | $625 | — | — | — | $625 – $625 |
| 12 | Charles A. Dean Memorial Hospital Greenville, ME professional · fee schedule · outpatient | 1 | $43 | $43 | — | — | — | $43 – $43 |
| 13 | Cheshire Medical Center Keene, NH professional · fee schedule · outpatient | 1 | $43 | $43 | — | — | — | $43 – $43 |
| 14 | Children's Hospital of the King's Daughters Norfolk, VA facility · percent of total billed charges · outpatientfrom % of charges | 1 | $26 | $26 | — | — | — | $26 – $26 |
| 15 | Chilton Medical Center Pompton Plains, NJ other · outpatient | 2 | $625 | $625 | — | — | — | $625 – $625 |
| 16 | Duplin General Hospital, Inc. Kenansville, NC percent of total billed charges · bothfrom % of charges | 1 | $170 | $170 | $27 | 16% | — | $143 – $197 |
| 17 | East Carolina Health Ahoskie, NC percent of total billed charges · bothfrom % of charges | 1 | $166 | $166 | $26 | 16% | — | $140 – $192 |
| 18 | East Carolina Health-Chowan, Inc. Edenton, NC percent of total billed charges · bothfrom % of charges | 1 | $202 | $202 | $32 | 16% | — | $171 – $234 |
| 19 | East Carolina Health-Heritage, Inc. Tarboro, NC percent of total billed charges · bothfrom % of charges | 1 | $114 | $114 | $18 | 16% | — | $96 – $132 |
| 20 | Eastern Maine Medical Center Bangor, ME professional · fee schedule · outpatient | 1 | $43 | $43 | — | — | — | $43 – $43 |
| 21 | Fairview Bethesda Hospital St. Paul, MN fee schedule · both | 1 | $50 | $50 | — | — | — | $50 – $50 |
| 22 | Fairview Health Services Edina, MN fee schedule · both | 1 | $50 | $50 | — | — | — | $50 – $50 |
| 23 | Fairview Health Services Minneapolis, MN fee schedule · both | 1 | $50 | $50 | — | — | — | $50 – $50 |
| 24 | Fairview Health Services Burnsville, MN fee schedule · both | 1 | $50 | $50 | — | — | — | $50 – $50 |
| 25 | Fairview Health Services Wyoming, MN fee schedule · both | 1 | $50 | $50 | — | — | — | $50 – $50 |
← Payers reporting HCPCS A9510 · Snapshot 20261111T120946Z-9134e7f7