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
Non-Heu Tc-99m Add-on per Dose
Low
$0
Average
$9
Median
$10
High
$42
Each hospital's average Molina rate, under the methodology and billing class chosen below.
229 hospitals; the 90th percentile is 45.5× 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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265 hospital rates
iThe hospitals that file a Molina 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 | Covenant Medical Center Inc Saginaw, MI facility · other · outpatient | 1 | $16 | $16 | — | — | 333 | $16 – $16 |
| 2 | Brigham and Women's Hospital Boston, MA other · both | 1 | $10 | $10 | — | — | 1–10 | $10 – $10 |
| 3 | Massachusetts General Hospital Boston, MA other · both | 1 | $10 | $10 | — | — | 1–10 | $10 – $10 |
| 4 | Newton Wellesley Hospital Newton, MA other · both | 1 | $10 | $10 | — | — | 1–10 | $10 – $10 |
| 5 | Salem Hospital Salem, MA other · both | 1 | $10 | $10 | — | — | 1–10 | $10 – $10 |
| 6 | AKRON GENERAL MEDICAL CENTER Akron, OH facility · case rate · outpatient | 1 | $22 | $22 | — | — | — | $22 – $22 |
| 7 | ALLE-KISKI MEDICAL CENTER NATRONA HEIGHTS, PA fee schedule · outpatient | 1 | $11 | $11 | — | — | — | $11 – $11 |
| 8 | Advocate Childrens Hospital Oak Lawn Oak Lawn, IL facility · case rate · outpatient | 1 | $15 | $15 | — | — | — | $15 – $15 |
| 9 | Advocate Childrens Hospital Park Ridge Park Ridge, IL facility · case rate · outpatient | 1 | $15 | $15 | — | — | — | $15 – $15 |
| 10 | Advocate Christ Medical Center Oak Lawn, IL facility · case rate · outpatient | 1 | $15 | $15 | — | — | — | $15 – $15 |
| 11 | Advocate Condell Medical Center Libertyville, IL case rate · outpatient | 1 | $15 | $15 | — | — | — | $15 – $15 |
| 12 | Advocate Good Samaritan Hospital Downers Grove, IL case rate · outpatient | 1 | $15 | $15 | — | — | — | $15 – $15 |
| 13 | Advocate Good Shepherd Hospital Barrington, IL case rate · outpatient | 1 | $15 | $15 | — | — | — | $15 – $15 |
| 14 | Advocate Illinois Masonic Medical Center Chicago, IL case rate · outpatient | 1 | $15 | $15 | — | — | — | $15 – $15 |
| 15 | Advocate Lutheran General Hospital Park Ridge, IL case rate · outpatient | 1 | $15 | $15 | — | — | — | $15 – $15 |
| 16 | Advocate Sherman Hospital Elgin, IL case rate · outpatient | 1 | $15 | $15 | — | — | — | $15 – $15 |
| 17 | Advocate South Suburban Hospital Hazel Crest, IL case rate · outpatient | 1 | $15 | $15 | — | — | — | $15 – $15 |
| 18 | Advocate Trinity Hospital Chicago, IL case rate · outpatient | 1 | $15 | $15 | — | — | — | $15 – $15 |
| 19 | Allen Memorial Hospital Corporation Waterloo, IA case rate · outpatient | 1 | $10 | $10 | — | — | — | $10 – $10 |
| 20 | Aurora BayCare Medical Center Green Bay, WI percent of total billed charges · outpatientfrom % of charges | 1 | $6 | $6 | — | — | — | $6 – $6 |
| 21 | Aurora Lakeland Medical Center Elkhorn, WI percent of total billed charges · outpatientfrom % of charges | 1 | $6 | $6 | — | — | — | $6 – $6 |
| 22 | Aurora Medical Center Bay Area Marinette, WI percent of total billed charges · outpatientfrom % of charges | 1 | $6 | $6 | — | — | — | $6 – $6 |
| 23 | Aurora Medical Center Burlington Burlington, WI percent of total billed charges · outpatientfrom % of charges | 1 | $6 | $6 | — | — | — | $6 – $6 |
| 24 | Aurora Medical Center Fond du Lac Fond Du Lac, WI percent of total billed charges · outpatientfrom % of charges | 1 | $6 | $6 | — | — | — | $6 – $6 |
| 25 | Aurora Medical Center Grafton Grafton, WI percent of total billed charges · outpatientfrom % of charges | 1 | $6 | $6 | — | — | — | $6 – $6 |
← Payers reporting HCPCS Q9969 · Snapshot 20261111T120946Z-9134e7f7