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
NM DOSE I 123 DIAG CAP PER 100 UCI UP TO 999 UCI
Ulm, MN
See all hospitals reporting HCPCS A9516 →Price type
Allina Health Systems’s median price of $62 is 65% below the median hospital's median price ($178), higher than 6% of the 1,910 hospitals reporting HCPCS A9516. The highlighted bar is where this hospital falls; shaded is the middle 50% of hospitals.
Negotiated rates from the hospital’s own file: 9 payers, 24 plan rates. A facility fee, a professional fee, a per diem and a case rate are different bills, so each is listed on its own. Open a payer to see it across hospitals.
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| # | |||||||
|---|---|---|---|---|---|---|---|
| 1 | Ucare ucare pmap (abdmnorsuv) facility · percent of total billed charges · outpatientfrom % of charges | $16 | $16 | — | — | — | $16 – $16 |
| 2 | Medica medica pmap (n) facility · percent of total billed charges · outpatientfrom % of charges | $26 | $26 | — | — | — | $26 – $26 |
| 3 | Medicaid medicaid ma (n) facility · other · outpatient | $35 | $35 | — | — | — | $35 – $35 |
| 4 | Medica medica medicare (r) facility · fee schedule · outpatient | $36 | $36 | — | — | — | $36 – $36 |
| 5 | Medica medica dual solutions (r) facility · percent of total billed charges · outpatientfrom % of charges | $36 | $36 | — | — | — | $36 – $36 |
| 6 | Blue Cross Blue Shield bc medicare (n) facility · fee schedule · outpatient | $37 | $37 | — | — | — | $37 – $37 |
| 7 | UnitedHealthcare united healthcare (nr) facility · percent of total billed charges · outpatientfrom % of charges | $40 | $40 | — | — | — | $40 – $40 |
| 8 | Aetna aetna elevate (n r) facility · percent of total billed charges · inpatientfrom % of charges | $49 | $49 | — | — | — | $49 – $49 |
| 9 | Aetna aetna elevate (n r) facility · percent of total billed charges · outpatientfrom % of charges | $50 | $50 | — | — | — | $50 – $50 |
| 10 | Aetna aetna performance (n r) facility · percent of total billed charges · inpatientfrom % of charges | $53 | $53 | — | — | — | $53 – $53 |
| 11 | Aetna aetna performance (n r) facility · percent of total billed charges · outpatientfrom % of charges | $54 | $54 | — | — | — | $54 – $54 |
| 12 | Medica medica ubh (n) facility · percent of total billed charges · inpatientfrom % of charges | $56 | $56 | — | — | — | $56 – $56 |
| 13 | Medica medica ubh pmap (n) facility · percent of total billed charges · outpatientfrom % of charges | $64 | $64 | — | — | — | $64 – $64 |
| 14 | Cigna hpi cigna (n) facility · other · outpatient | $66 | $66 | — | — | — | $66 – $66 |
| 15 | First Health first health (abdmnosurv) facility · percent of total billed charges · inpatientfrom % of charges | $68 | $68 | — | — | — | $68 – $68 |
| 16 | First Health first health (abdmnosurv) facility · percent of total billed charges · outpatientfrom % of charges | $68 | $68 | — | — | — | $68 – $68 |
| 17 | Medica medica ubh (n) facility · percent of total billed charges · outpatientfrom % of charges | $68 | $68 | — | — | — | $68 – $68 |
| 18 | Aetna aetna direct/indirect network (n r) facility · percent of total billed charges · inpatientfrom % of charges | $68 | $68 | — | — | — | $68 – $68 |
| 19 | Aetna aetna direct/indirect network (n r) facility · percent of total billed charges · outpatientfrom % of charges | $69 | $69 | — | — | — | $69 – $69 |
| 20 | Bcbs Mn bc pmap (n) facility · other · outpatient | $317 | $317 | — | — | — | $317 – $317 |
| 21 | Bcbs Mn bc state health plan (n) facility · other · outpatient | $855 | $855 | — | — | — | $855 – $855 |
| 22 | Bcbs Mn bc premier(n) facility · other · outpatient | $1.1k | $1.1k | — | — | — | $1.1k – $1.1k |
| 23 | Blue Cross Blue Shield bc aehp (n) facility · other · outpatient | $1.3k | $1.3k | — | — | — | $1.3k – $1.3k |
| 24 | Bcbs Mn bc high value/performance network (n) facility · other · outpatient | $1.4k | $1.4k | — | — | — | $1.4k – $1.4k |
Last updated: Jun 16, 2026
See Iodine-123 diagnostic dose, 100-999 microcuries pricing across every hospital in the network reporting it, or ask Claude or any MCP client directly — see how to connect.