Technetium-99m radioactive tracer dose, domestic low-enriched uranium source

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

TC-99M FROM DOMESTICALLY PRODUCED NON-HEU MO-99, [MINIMUM 50 PERCENT], FULL COST RECOVERY ADD-ON, PER STUDY DOSE

Payers reporting HCPCS C9176

Payer pricing summary

Low

Average

$235

Median

$12

High

$5.0k

Payer rate distribution

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#
1	Sanford Health Plan percent of total billed charges · bothfrom % of charges	1	$53	$53	—	—	25	$53 – $53
2	UnitedHealthcare fee schedule · outpatient · +15 other terms	216	$17	$18	$5	30%	—	$9 – $38
3	Aetna facility · fee schedule · outpatient · +13 other terms	67	$10	$10	$2	15%	—	$3 – $20
4	Molina facility · fee schedule · outpatient · +8 other terms	47	$10	$10	$3	29%	—	$5 – $23
5	Humana facility · fee schedule · outpatient · +11 other terms	45	$10	$10	$0	2%	—	$10 – $11
6	MultiPlan facility · percent of total billed charges · outpatientfrom % of charges · +4 other terms	37	$10	$758	$3.6k	471%	—	$1 – $18.3k
7	Blue Cross Blue Shield fee schedule · outpatient · +10 other terms	35	$24	$31	$24	78%	—	$5 – $160
8	WellCare fee schedule · outpatient · +8 other terms	27	$10	$10	$1	6%	—	$10 – $12
9	Cigna fee schedule · outpatient · +10 other terms	26	$10	$12	$5	41%	—	$10 – $24
10	Devoted facility · fee schedule · outpatient · +4 other terms	24	$10	$10	$0	4%	—	$10 – $11
11	Anthem facility · fee schedule · outpatient · +8 other terms	22	$10	$14	$6	43%	—	$10 – $30
12	Kaiser fee schedule · outpatient · +3 other terms	22	$10	$24	$19	81%	—	$10 – $79
13	Healthcare Highways facility · percent of total billed charges · bothfrom % of charges	19	$10	$10	$6	59%	—	$4 – $29
14	Ambetter fee schedule · outpatient · +5 other terms	18	$18	$19	$3	17%	—	$17 – $27
15	Medicare fee schedule · outpatient · +4 other terms	18	$10	$10	—	—	—	$10 – $10
16	Caresource facility · case rate · outpatient · +5 other terms	17	$117	$112	$49	44%	—	$20 – $203
17	Regence facility · fee schedule · outpatient · +1 other terms	15	$10	$10	$0	1%	—	$10 – $11
18	Medical Mutual facility · fee schedule · outpatient · +2 other terms	13	$10	$12	$3	21%	—	$10 – $16
19	Optum fee schedule · outpatient · +4 other terms	12	$10	$13	$7	54%	—	$10 – $29
20	Excellus fee schedule · outpatient · +1 other terms	6	$10	$13	$5	36%	—	$10 – $22
21	Aetna Better Health facility · fee schedule · outpatient · +1 other terms	5	$5	$5	$0	1%	—	$5 – $5
22	Highmark fee schedule · outpatient · +1 other terms	5	$10	$14	$5	35%	—	$10 – $22
23	Tricare facility · fee schedule · outpatient · +1 other terms	4	$10	$6.3k	$10.8k	173%	—	$4 – $25k
24	Bcbs Il facility · percent of total billed charges · outpatientfrom % of charges · +1 other terms	3	$0	$0	$0	23%	—	$0 – $1
25	First Health professional · fee schedule · outpatient · +5 other terms	3	$9	$9	—	—	—	$9 – $9

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