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
XENON XE-133 DX PER 10MCI
Los Angeles, CA
See all hospitals reporting HCPCS A9558 →Price type
Dignity Community Care’s median price of $78 is 75% below the median hospital's median price ($309), higher than 7% of the 1,449 hospitals reporting HCPCS A9558. The highlighted bar is where this hospital falls; shaded is the middle 50% of hospitals.
Negotiated rates from the hospital’s own file: 7 payers, 18 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 | Anthem commercial|exchange fee schedule · outpatient | $50 | $50 | — | — | — | $50 – $50 |
| 2 | First Health commercial|all plans fee schedule · inpatient | $54 | $54 | — | — | — | $54 – $54 |
| 3 | First Health commercial|all plans fee schedule · outpatient | $54 | $54 | — | — | — | $54 – $54 |
| 4 | Kaiser commercial|all plans fee schedule · inpatient | $55 | $55 | — | — | — | $55 – $55 |
| 5 | Kaiser commercial|all plans fee schedule · outpatient | $55 | $55 | — | — | — | $55 – $55 |
| 6 | Blue Cross Blue Shield medicare|promise fee schedule · outpatient | $59 | $59 | — | — | — | $59 – $59 |
| 7 | MultiPlan commercial|all plans fee schedule · inpatient | $62 | $62 | — | — | — | $62 – $62 |
| 8 | MultiPlan commercial|all plans fee schedule · outpatient | $62 | $62 | — | — | — | $62 – $62 |
| 9 | Anthem commercial|all other plans fee schedule · outpatient | $75 | $75 | — | — | — | $75 – $75 |
| 10 | Anthem commercial|mcs fee schedule · outpatient | $78 | $78 | — | — | — | $78 – $78 |
| 11 | Anthem medicaid|all plans fee schedule · outpatient | $78 | $78 | — | — | — | $78 – $78 |
| 12 | Molina medicaid|< 21 fee schedule · outpatient | $78 | $78 | — | — | — | $78 – $78 |
| 13 | Molina medicaid|> 21 fee schedule · outpatient | $78 | $78 | — | — | — | $78 – $78 |
| 14 | UnitedHealthcare commercial|hmo fee schedule · outpatient | $78 | $78 | — | — | — | $78 – $78 |
| 15 | UnitedHealthcare commercial|ppo fee schedule · outpatient | $78 | $78 | — | — | — | $78 – $78 |
| 16 | Kaiser medicaid|< 21 fee schedule · outpatient | $117 | $117 | — | — | — | $117 – $117 |
| 17 | Kaiser medicaid|> 21 fee schedule · outpatient | $117 | $117 | — | — | — | $117 – $117 |
| 18 | Blue Cross Blue Shield medicaid|all plans fee schedule · outpatient | $1.2k | $1.2k | — | — | — | $1.2k – $1.2k |
Last updated: Feb 28, 2026
See Xenon-133 gas for diagnostic imaging pricing across every hospital in the network reporting it, or ask Claude or any MCP client directly — see how to connect.