Iodine-125 sodium iothalamate test dose

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 1-125 Iothalamate -Glofil

Payers reporting HCPCS A9554

Payer pricing summary

Low

$36

Average

$1.1k

Median

$649

High

$7.4k

Payer rate distribution

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Filter by billing class

#
1	UnitedHealthcare fee schedule · outpatient · +15 other terms	419	$662	$719	$633	88%	—	$34 – $4.2k
2	Aetna fee schedule · outpatient · +14 other terms	241	$650	$406	$354	87%	—	$36 – $2.3k
3	Cigna fee schedule · outpatient · +13 other terms	234	$105	$241	$296	123%	—	$35 – $2.2k
4	Blue Cross Blue Shield fee schedule · outpatient · +12 other terms	223	$231	$314	$404	129%	—	$1 – $2.4k
5	Humana fee schedule · outpatient · +14 other terms	159	$594	$474	$269	57%	—	$36 – $1.8k
6	Molina facility · fee schedule · outpatient · +9 other terms	67	$661	$650	$221	34%	—	$18 – $1.5k
7	Anthem facility · fee schedule · outpatient · +11 other terms	66	$650	$428	$475	111%	—	$37 – $1.9k
8	WellCare fee schedule · outpatient · +5 other terms	45	$663	$671	$55	8%	—	$606 – $873
9	Kaiser fee schedule · both · +8 other terms	41	$62	$59	$16	27%	—	$43 – $85
10	Optum fee schedule · outpatient · +4 other terms	38	$637	$853	$398	47%	—	$490 – $1.9k
11	Ambetter fee schedule · outpatient · +6 other terms	33	$1.2k	$1.2k	$206	17%	—	$877 – $1.8k
12	Devoted fee schedule · outpatient · +2 other terms	33	$637	$634	$33	5%	—	$591 – $695
13	Bcbs Tx fee schedule · outpatient · +1 other terms	30	$151	$137	$46	33%	—	$56 – $237
14	Caresource facility · fee schedule · outpatient · +8 other terms	26	$984	$932	$339	36%	—	$51 – $1.3k
15	Oscar facility · fee schedule · outpatient · +5 other terms	21	$974	$974	$170	17%	—	$669 – $1.2k
16	Amerihealth Caritas percent of total billed charges · outpatientfrom % of charges	19	$491	$861	$758	88%	—	$228 – $2.6k
17	Medicare fee schedule · outpatient · +1 other terms	18	$637	$637	—	—	—	$637 – $637
18	Magellan percent of total billed charges · outpatientfrom % of charges	17	$1.4k	$1.5k	$410	27%	—	$1.1k – $2.6k
19	Phcs percent of total billed charges · bothfrom % of charges · +3 other terms	17	$8.9k	$8.6k	$1.5k	17%	—	$5.8k – $10.9k
20	Highmark fee schedule · outpatient · +6 other terms	16	$38	$67	$164	245%	—	$34 – $1.4k
21	Regence facility · fee schedule · outpatient · +5 other terms	16	$676	$686	$32	5%	—	$650 – $804
22	Tricare fee schedule · outpatient · +2 other terms	16	$618	$1.2k	$844	73%	—	$577 – $2.4k
23	Medical Mutual facility · fee schedule · outpatient · +1 other terms	14	$650	$869	$458	53%	—	$354 – $2.6k
24	Medcost percent of total billed charges · inpatientfrom % of charges · +2 other terms	13	$1.3k	$1.4k	$371	27%	—	$698 – $2.6k
25	Bcbs Mn fee schedule · outpatient · +3 other terms	12	$62	$40	$34	86%	—	$0 – $78

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