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
$1
Average
$1.2k
Median
$931
High
$5.7k
Each hospital's average Medicaid rate, under the methodology and billing class chosen below.
46 hospitals; the 90th percentile is 2577.9× 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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52 hospital rates
iThe hospitals that file a Medicaid 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 | ACADIAN MEDICAL CENTER EUNICE, LA percent of total billed charges · bothfrom % of charges | 6 | $2.6k | $2.6k | $1.8k | 68% | — | $818 – $4.3k |
| 2 | Allina Health Systems Ulm, MN facility · other · outpatient | 1 | $2.6k | $2.6k | — | — | — | $2.6k – $2.6k |
| 3 | Bullhead City Hospital Corporation City, AZ facility · other · outpatient | 2 | $798 | $798 | $281 | 35% | — | $517 – $1.1k |
| 4 | CATHOLIC HEALTH INITIATIVES COLORADO Salt Lake City, UT fee schedule · outpatient | 1 | $934 | $934 | — | — | — | $934 – $934 |
| 5 | CentraState Medical Center Freehold Township, NJ percent of total billed charges · bothfrom % of charges | 1 | $621 | $621 | — | — | — | $621 – $621 |
| 6 | Chapman Global Medical Center Orange, CA facility · fee schedule · outpatient | 1 | $413 | $413 | — | — | — | $413 – $413 |
| 7 | Chilton Medical Center Pompton Plains, NJ percent of total billed charges · bothfrom % of charges | 1 | $1.3k | $1.3k | — | — | — | $1.3k – $1.3k |
| 8 | Geisinger Bloomsburg Hospital Bloomsburg, PA fee schedule · outpatient | 1 | $1 | $1 | — | — | — | $1 – $1 |
| 9 | Geisinger Community Medical Center Scranton, PA fee schedule · outpatient | 1 | $1 | $1 | — | — | — | $1 – $1 |
| 10 | Geisinger Jersey Shore Hospital Jersey Shore, PA fee schedule · outpatient | 1 | $1 | $1 | — | — | — | $1 – $1 |
| 11 | Geisinger Lewistown Hospital Lewistown, PA fee schedule · outpatient | 1 | $1 | $1 | — | — | — | $1 – $1 |
| 12 | Geisinger Medical Center Muncy, PA fee schedule · outpatient | 1 | $1 | $1 | — | — | — | $1 – $1 |
| 13 | Geisinger Wyoming Valley Wilkes-Barre, PA fee schedule · outpatient | 1 | $1 | $1 | — | — | — | $1 – $1 |
| 14 | Hackettstown Medical Center Hackettstown, NJ percent of total billed charges · bothfrom % of charges | 1 | $830 | $830 | — | — | — | $830 – $830 |
| 15 | HealthAlliance - Clinton Hospital MA 01453; 201 Highland St Clinton, MA other · both | 1 | $934 | $934 | — | — | — | $934 – $934 |
| 16 | HealthAlliance - Clinton Hospital MA 01453; 201 Highland St Clinton, MA percent of total billed charges · bothfrom % of charges | 1 | $6.1k | $6.1k | — | — | — | $6.1k – $6.1k |
| 17 | Hospital Service District #1, Parish of Terrebonne, State of Louisiana dba Terrebonne General Health System Houma, LA facility · other · outpatient | 1 | $698 | $698 | — | — | — | $698 – $698 |
| 18 | Kirksville Missouri Hospital Co LLC PO Box C8502 Kirksville, MO facility · fee schedule · outpatient | 1 | $936 | $936 | — | — | — | $936 – $936 |
| 19 | Lake Charles Memorial Hospital Charles., LA percent of total billed charges · outpatientfrom % of charges | 1 | $445 | $445 | — | — | — | $445 – $445 |
| 20 | Lowell General Hospital Lowell, MA percent of total billed charges · bothfrom % of charges | 1 | $1.5k | $1.5k | — | — | — | $1.5k – $1.5k |
| 21 | MELROSEWAKEFIELD HEALTHCARE Medford, MA percent of total billed charges · bothfrom % of charges | 1 | $1.5k | $1.5k | $321 | 21% | — | $1.2k – $1.9k |
| 22 | Mercy Hospital Ardmore Inc Ardmore, OK facility · fee schedule · outpatient | 1 | $926 | $926 | — | — | — | $926 – $926 |
| 23 | Mercy Hospital Berryville Berryville, AR facility · fee schedule · outpatient | 2 | $931 | $931 | $5 | 1% | — | $926 – $936 |
| 24 | Mercy Hospital Fort Smith Smith, AR facility · fee schedule · outpatient | 2 | $931 | $931 | $5 | 1% | — | $926 – $936 |
| 25 | Mercy Hospital Fort Smith Smith, AR facility · fee schedule · outpatient | 2 | $931 | $931 | $5 | 1% | — | $926 – $936 |
← Payers reporting HCPCS A9569 · Snapshot 20261111T120946Z-9134e7f7