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
TC-99M-EXAMETAZIME 0.5 MG INTRAVENOUS KIT (WBC)
Low
$226
Average
$1.3k
Median
$1.1k
High
$4.1k
Each hospital's average Aetna Better Health rate, under the methodology and billing class chosen below.
56 hospitals; the 90th percentile is 5.0× 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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70 hospital rates
iThe hospitals that file a Aetna Better Health 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 | ACADIA GENERAL HOSPITAL, INC 1305 CROWLEY RAYNE HWY other · outpatient | 1 | $226 | $226 | — | — | — | $226 – $226 |
| 2 | ACADIAN MEDICAL CENTER EUNICE, LA percent of total billed charges · bothfrom % of charges | 2 | $818 | $818 | — | — | — | $818 – $818 |
| 3 | Capital Health System Inc Trenton, NJ percent of total billed charges · outpatientfrom % of charges | 1 | $540 | $540 | — | — | — | $540 – $540 |
| 4 | Capital Health System Inc Browns Mills, NJ percent of total billed charges · outpatientfrom % of charges | 1 | $540 | $540 | — | — | — | $540 – $540 |
| 5 | Carle BroMenn Medical Center Normal, IL fee schedule · inpatient | 1 | $1.7k | $1.7k | — | — | — | $1.7k – $1.7k |
| 6 | Carle BroMenn Medical Center Normal, IL fee schedule · outpatient | 1 | $1.7k | $1.7k | — | — | — | $1.7k – $1.7k |
| 7 | Carle Eureka Hospital Eureka, IL fee schedule · inpatient | 1 | $1.7k | $1.7k | — | — | — | $1.7k – $1.7k |
| 8 | Carle Eureka Hospital Eureka, IL fee schedule · outpatient | 1 | $1.7k | $1.7k | — | — | — | $1.7k – $1.7k |
| 9 | CentraState Medical Center Freehold Township, NJ percent of total billed charges · bothfrom % of charges | 1 | $745 | $745 | — | — | — | $745 – $745 |
| 10 | Children's Hospital of Philadelphia, The Philadelphia, PA percent of total billed charges · outpatientfrom % of charges | 1 | $930 | $930 | — | — | — | $930 – $930 |
| 11 | Chilton Medical Center Pompton Plains, NJ percent of total billed charges · bothfrom % of charges | 1 | $1.5k | $1.5k | — | — | — | $1.5k – $1.5k |
| 12 | Deaconess Illinois Crossroads Inc Mount Vernon, IL facility · case rate · outpatient | 1 | $1.1k | $1.1k | — | — | — | $1.1k – $1.1k |
| 13 | Deaconess Regional Healthcare Services Illinois Inc Marion, IL facility · case rate · outpatient | 1 | $1.1k | $1.1k | — | — | — | $1.1k – $1.1k |
| 14 | EAST BATON ROUGE MEDICAL CENTER, LLC Baton Rouge, LA other · outpatient | 1 | $1.4k | $1.4k | — | — | — | $1.4k – $1.4k |
| 15 | GRMC, Inc. Oakland, MD percent of total billed charges · bothfrom % of charges | 3 | $2.1k | $2.1k | $421 | 20% | — | $1.6k – $2.5k |
| 16 | Hackettstown Medical Center Hackettstown, NJ percent of total billed charges · bothfrom % of charges | 1 | $997 | $997 | — | — | — | $997 – $997 |
| 17 | Henry Ford Health System West Bloomfield, MI facility · fee schedule · outpatient | 1 | $498 | $498 | — | — | — | $498 – $498 |
| 18 | Henry Ford Health System Plymouth, MI facility · fee schedule · outpatient | 1 | $498 | $498 | — | — | — | $498 – $498 |
| 19 | Henry Ford Macomb Hospital Corporation Clinton Twp, MI facility · fee schedule · outpatient | 1 | $498 | $498 | — | — | — | $498 – $498 |
| 20 | Henry Ford Wyandotte Hospital Brownstown Charter Twp., MI facility · fee schedule · outpatient | 1 | $498 | $498 | — | — | — | $498 – $498 |
| 21 | Hoopeston Community Memorial Hospital Hoopeston, IL fee schedule · inpatient | 1 | $1.7k | $1.7k | — | — | — | $1.7k – $1.7k |
| 22 | Hoopeston Community Memorial Hospital Hoopeston, IL fee schedule · outpatient | 1 | $1.7k | $1.7k | — | — | — | $1.7k – $1.7k |
| 23 | Inspira Health Center Bridgeton Bridgeton, NJ percent of total billed charges · outpatientfrom % of charges | 1 | $1.1k | $1.1k | — | — | — | $1.1k – $1.1k |
| 24 | Inspira Health Center Woodbury Woodbury, NJ percent of total billed charges · outpatientfrom % of charges | 1 | $1.1k | $1.1k | — | — | — | $1.1k – $1.1k |
| 25 | Inspira Medical Center Elmer Elmer, NJ percent of total billed charges · outpatientfrom % of charges | 1 | $1.2k | $1.2k | — | — | — | $1.2k – $1.2k |
← Payers reporting HCPCS A9569 · Snapshot 20261111T120946Z-9134e7f7