Iodine-131 sodium iodide oral capsule therapy

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

HC Si I-131 Capsule Tx/Mci

Payers reporting HCPCS A9517

Payer pricing summary

Low

Average

$1.0k

Median

$173

High

$16.3k

Payer rate distribution

Filter by billing methodology

Filter by billing class

#
1	Blue Cross Blue Shield fee schedule · outpatient · +29 other terms	319	$43	$95	$233	246%	252–306	$0 – $2.1k
2	UnitedHealthcare fee schedule · outpatient · +30 other terms	659	$39	$47	$94	200%	5–50	$1 – $2.3k
3	Aetna fee schedule · outpatient · +28 other terms	411	$25	$94	$322	343%	5–50	$0 – $3.0k
4	Anthem fee schedule · outpatient · +25 other terms	141	$27	$59	$148	250%	5–50	$0 – $1.8k
5	Bcbs Al facility · other · outpatient · +3 other terms	3	$710	$716	$42	6%	4–40	$663 – $781
6	Cigna fee schedule · outpatient · +24 other terms	334	$100	$331	$771	233%	2–20	$1 – $5.3k
7	Molina fee schedule · outpatient · +25 other terms	150	$36	$84	$131	157%	1–10	$1 – $1.1k
8	Bcbs Fl facility · other · outpatient · +3 other terms	2	$808	$808	$682	84%	1–10	$158 – $2.0k
9	Bcbs Wy other · both · +2 other terms	1	$12.2k	$12.2k	—	—	1–10	$12.2k – $12.2k
10	Humana fee schedule · outpatient · +25 other terms	297	$25	$75	$118	157%	—	$1 – $584
11	WellCare fee schedule · outpatient · +18 other terms	133	$24	$30	$40	133%	—	$7 – $423
12	Kaiser fee schedule · outpatient · +19 other terms	93	$39	$150	$389	259%	—	$4 – $2.2k
13	MultiPlan fee schedule · outpatient · +17 other terms	76	$59	$84	$115	137%	—	$17 – $752
14	Ambetter facility · fee schedule · outpatient · +16 other terms	68	$42	$40	$11	28%	—	$23 – $59
15	Devoted fee schedule · outpatient · +13 other terms	62	$24	$24	$1	4%	—	$22 – $26
16	Oscar facility · fee schedule · outpatient · +16 other terms	51	$38	$36	$5	15%	—	$25 – $45
17	Optum fee schedule · outpatient · +17 other terms	49	$24	$30	$14	46%	—	$18 – $69
18	Highmark facility · fee schedule · outpatient · +14 other terms	46	$46	$72	$92	128%	—	$19 – $641
19	Caresource fee schedule · outpatient · +15 other terms	45	$37	$55	$50	91%	—	$1 – $504
20	Medicare facility · fee schedule · outpatient · +14 other terms	35	$24	$30	$27	88%	—	$23 – $160
21	Medicaid facility · fee schedule · outpatient · +14 other terms	31	$25	$79	$163	205%	—	$21 – $721
22	Tricare fee schedule · outpatient · +14 other terms	30	$24	$31	$14	45%	—	$21 – $57
23	Clover facility · fee schedule · outpatient · +7 other terms	27	$25	$25	$1	5%	—	$23 – $27
24	First Health fee schedule · outpatient · +16 other terms	26	$49	$87	$117	135%	—	$14 – $657
25	Wellmark facility · fee schedule · both · +12 other terms	26	$218	$264	$154	58%	—	$41 – $902

Page 1 of 3 · 64 payers