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 TEBOROXIME PER STY DOSE
Duluth, GA
See all hospitals reporting HCPCS A9501 →Price type
Northside Hospital, Inc.’s median price of $650 is 325% above the median hospital's median price ($153), higher than 94% of the 192 hospitals reporting HCPCS A9501. The highlighted bar is where this hospital falls; shaded is the middle 50% of hospitals.
Negotiated rates from the hospital’s own file: 8 payers, 50 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 | Caresource caresource other · outpatient | $130 | $130 | — | — | — | $130 – $130 |
| 2 | Cigna cigna healthsprings medicare advantage other · outpatient | $174 | $174 | — | — | — | $174 – $174 |
| 3 | Blue Cross Blue Shield bcbs_pathway other · outpatient | $279 | $279 | — | — | — | $279 – $279 |
| 4 | Blue Cross Blue Shield bcbs_pathway-l other · outpatient | $279 | $279 | — | — | — | $279 – $279 |
| 5 | Caresource caresource marketplace percent of total billed charges · inpatientfrom % of charges | $372 | $372 | — | — | — | $372 – $372 |
| 6 | Caresource caresource marketplace percent of total billed charges · outpatientfrom % of charges | $372 | $372 | — | — | — | $372 – $372 |
| 7 | Blue Cross Blue Shield blue hpn other · outpatient | $432 | $432 | — | — | — | $432 – $432 |
| 8 | Blue Cross Blue Shield blue hpn-l other · outpatient | $432 | $432 | — | — | — | $432 – $432 |
| 9 | Oscar oscar percent of total billed charges · outpatientfrom % of charges | $470 | $470 | — | — | — | $470 – $470 |
| 10 | Blue Cross Blue Shield bcbs_hmo other · outpatient | $559 | $559 | — | — | — | $559 – $559 |
| 11 | Blue Cross Blue Shield bcbs_hmo-l other · outpatient | $559 | $559 | — | — | — | $559 – $559 |
| 12 | Kaiser kaiser_hmo percent of total billed charges · outpatientfrom % of charges | $650 | $650 | — | — | — | $650 – $650 |
| 13 | Kaiser kaiser_hmo-aga percent of total billed charges · outpatientfrom % of charges | $650 | $650 | — | — | — | $650 – $650 |
| 14 | Kaiser kaiser_hmo-bariatric percent of total billed charges · outpatientfrom % of charges | $650 | $650 | — | — | — | $650 – $650 |
| 15 | Kaiser kaiser_hmo-gcs percent of total billed charges · outpatientfrom % of charges | $650 | $650 | — | — | — | $650 – $650 |
| 16 | Kaiser kaiser_hmo-gpg/noas percent of total billed charges · outpatientfrom % of charges | $650 | $650 | — | — | — | $650 – $650 |
| 17 | Kaiser kaiser_hmo-gynonc percent of total billed charges · outpatientfrom % of charges | $650 | $650 | — | — | — | $650 – $650 |
| 18 | Kaiser kaiser_hmo-melanoma percent of total billed charges · outpatientfrom % of charges | $650 | $650 | — | — | — | $650 – $650 |
| 19 | Kaiser kaiser_hmo-naps/cvg/npcps/ups percent of total billed charges · outpatientfrom % of charges | $650 | $650 | — | — | — | $650 – $650 |
| 20 | Kaiser kaiser_hmo-vasc surg percent of total billed charges · outpatientfrom % of charges | $650 | $650 | — | — | — | $650 – $650 |
| 21 | Kaiser kaiser_sf percent of total billed charges · outpatientfrom % of charges | $650 | $650 | — | — | — | $650 – $650 |
| 22 | Kaiser kaiser_sf-aga percent of total billed charges · outpatientfrom % of charges | $650 | $650 | — | — | — | $650 – $650 |
| 23 | Kaiser kaiser_sf-bariatric percent of total billed charges · outpatientfrom % of charges | $650 | $650 | — | — | — | $650 – $650 |
| 24 | Kaiser kaiser_sf-gcs percent of total billed charges · outpatientfrom % of charges | $650 | $650 | — | — | — | $650 – $650 |
| 25 | Kaiser kaiser_sf-gpg/noas percent of total billed charges · outpatientfrom % of charges | $650 | $650 | — | — | — | $650 – $650 |
Last updated: Feb 14, 2026
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