Xenon-133 gas for diagnostic imaging at Proctor Community Hospital

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.

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Provider: anthropic
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Max output tokens: 4096
Prompt version (hash): 444523875572
Generated: October 20, 2026

Original text from hospital filings

Xenon Xe-133 Gas per 10mci

Peoria, IL

See all hospitals reporting HCPCS A9558 →

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How this price compares nationally

Proctor Community Hospital’s median price of $447 is 44% above the median hospital's median price ($309), higher than 67% of the 1,455 hospitals reporting HCPCS A9558. The highlighted bar is where this hospital falls; shaded is the middle 50% of hospitals.

Payers reporting HCPCS A9558 at Proctor Community Hospital

Negotiated rates from the hospital’s own file: 7 payers, 21 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	Aetna Better Health medicare-medicaid (d-snp) fee schedule · inpatient	$240	$240	—	—	—	$240 – $240
2	Aetna Better Health medicare-medicaid (d-snp) fee schedule · outpatient	$240	$240	—	—	—	$240 – $240
3	UnitedHealthcare va ccn fee schedule · inpatient	$276	$276	—	—	—	$276 – $276
4	UnitedHealthcare va ccn fee schedule · outpatient	$276	$276	—	—	—	$276 – $276
5	Aetna Better Health managed medicaid percent of total billed charges · inpatientfrom % of charges	$286	$286	—	—	—	$286 – $286
6	Aetna Better Health managed medicaid percent of total billed charges · outpatientfrom % of charges	$286	$286	—	—	—	$286 – $286
7	Molina managed medicaid percent of total billed charges · inpatientfrom % of charges	$344	$344	—	—	—	$344 – $344
8	Molina managed medicaid percent of total billed charges · outpatientfrom % of charges	$344	$344	—	—	—	$344 – $344
9	Molina medicare-medicaid (mmai/dual) percent of total billed charges · inpatientfrom % of charges	$344	$344	—	—	—	$344 – $344
10	Molina medicare-medicaid (mmai/dual) percent of total billed charges · outpatientfrom % of charges	$344	$344	—	—	—	$344 – $344
11	Blue Cross Blue Shield blue choice percent of total billed charges · outpatientfrom % of charges	$447	$447	—	—	—	$447 – $447
12	Blue Cross Blue Shield blue choice options percent of total billed charges · outpatientfrom % of charges	$447	$447	—	—	—	$447 – $447
13	Blue Cross Blue Shield ppo percent of total billed charges · outpatientfrom % of charges	$452	$452	—	—	—	$452 – $452
14	UnitedHealthcare ppo percent of total billed charges · inpatientfrom % of charges	$460	$460	—	—	—	$460 – $460
15	UnitedHealthcare ppo percent of total billed charges · outpatientfrom % of charges	$460	$460	—	—	—	$460 – $460
16	Blue Cross Blue Shield hmo percent of total billed charges · outpatientfrom % of charges	$552	$552	—	—	—	$552 – $552
17	Aetna commercial ppo percent of total billed charges · outpatientfrom % of charges	$561	$561	—	—	—	$561 – $561
18	Aetna medicare advantage percent of total billed charges · outpatientfrom % of charges	$573	$573	—	—	—	$573 – $573
19	MultiPlan ppo percent of total billed charges · inpatientfrom % of charges	$573	$573	—	—	—	$573 – $573
20	MultiPlan ppo percent of total billed charges · outpatientfrom % of charges	$573	$573	—	—	—	$573 – $573
21	Cigna ppo percent of total billed charges · outpatientfrom % of charges	$767	$767	—	—	—	$767 – $767

Last updated: Apr 15, 2026

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