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
$40
Average
$208
Median
$112
High
$2.2k
Each hospital's average Wellmark rate, under the methodology and billing class chosen below.
32 hospitals; the 90th percentile is 4.1× 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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33 hospital rates
iThe hospitals that file a Wellmark 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 | ALEGENT HEALTH - MERCY HOSPITAL, CORNING IOWA Corning, IA fee schedule · inpatient | 2 | $119 | $119 | — | — | — | $119 – $119 |
| 2 | ALEGENT HEALTH COMMUNITY MEMORIAL HOSPITAL OF MISSOURI VALLEY, IOWA Missouri Valley, IA fee schedule · inpatient | 2 | $113 | $113 | — | — | — | $113 – $113 |
| 3 | Central Community Hospital Elkader, IA facility · percent of total billed charges · bothfrom % of charges | 1 | $175 | $175 | — | — | — | $175 – $175 |
| 4 | Holy Cross Germantown Hospital Germantown, MD facility · percent of total billed charges · bothfrom % of charges | 1 | $355 | $355 | — | — | — | $355 – $355 |
| 5 | Holy Cross Hospital-Ft. Lauderdale Ft. Lauderdale, FL facility · case rate · both | 1 | $2.2k | $2.2k | — | — | — | $2.2k – $2.2k |
| 6 | Holy Cross Hospital-Silver Spring Silver Spring, MD facility · percent of total billed charges · bothfrom % of charges | 1 | $358 | $358 | — | — | — | $358 – $358 |
| 7 | Johnson Memorial Hospital Stafford Springs, CT facility · fee schedule · both | 1 | $295 | $295 | — | — | — | $295 – $295 |
| 8 | Mercy Fitzgerald Hospital Darby, PA facility · fee schedule · both | 1 | $71 | $71 | — | — | — | $71 – $71 |
| 9 | Mercy Health Hackley Campus Muskogen, MI facility · fee schedule · both | 1 | $102 | $102 | — | — | — | $102 – $102 |
| 10 | Mercy Health Lakeshore Campus Shelby, MI facility · percent of total billed charges · bothfrom % of charges | 1 | $290 | $290 | — | — | — | $290 – $290 |
| 11 | Mercy Health Saint Marys Rockford, MI facility · fee schedule · both | 1 | $105 | $105 | — | — | — | $105 – $105 |
| 12 | Mercy Hospital of Franciscan Sisters Inc Oelwein, IA facility · percent of total billed charges · bothfrom % of charges | 1 | $138 | $138 | — | — | — | $138 – $138 |
| 13 | Mercy Medical Center - Dyersville Dyersville, IA facility · percent of total billed charges · bothfrom % of charges | 1 | $188 | $188 | — | — | — | $188 – $188 |
| 14 | Mercy Medical Center - New Hampton New Hampton, IA facility · percent of total billed charges · bothfrom % of charges | 1 | $135 | $135 | — | — | — | $135 – $135 |
| 15 | Mount Sinai Rehabilitation Hospital, Inc Hartford, CT facility · fee schedule · both | 1 | $97 | $97 | — | — | — | $97 – $97 |
| 16 | Nazareth Hospital Philadelphia, PA facility · fee schedule · both | 1 | $71 | $71 | — | — | — | $71 – $71 |
| 17 | Saint Alphonsus Medical Center - Baker City Baker City, OR facility · percent of total billed charges · bothfrom % of charges | 1 | $297 | $297 | — | — | — | $297 – $297 |
| 18 | Saint Alphonsus Medical Center - Nampa Nampa, ID facility · fee schedule · both | 1 | $87 | $87 | — | — | — | $87 – $87 |
| 19 | Saint Alphonsus Regional Medical Center - Boise Boise, ID facility · fee schedule · both | 1 | $87 | $87 | — | — | — | $87 – $87 |
| 20 | Samaritan Hospital Troy, NY facility · percent of total billed charges · bothfrom % of charges | 2 | $112 | $112 | — | — | — | $112 – $112 |
| 21 | St Joseph Mercy Ann Arbor Ypsilanti, MI facility · fee schedule · both | 1 | $97 | $97 | — | — | — | $97 – $97 |
| 22 | St Joseph Mercy Chelsea Chelsea, MI facility · fee schedule · both | 1 | $98 | $98 | — | — | — | $98 – $98 |
| 23 | St Joseph Mercy Livingston Hospital | Trinity Health Medical Center - Brighton Brighton, MI facility · fee schedule · both | 1 | $131 | $131 | — | — | — | $131 – $131 |
| 24 | St Joseph Mercy Oakland Pontiac, MI facility · fee schedule · both | 1 | $84 | $84 | — | — | — | $84 – $84 |
| 25 | St Mary Medical Center Langhorne, PA facility · fee schedule · both | 1 | $71 | $71 | — | — | — | $71 – $71 |
← Payers reporting HCPCS A9510 · Snapshot 20261111T120946Z-9134e7f7