RC 636
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
HC A9521 MED: TECHNETIUM TC-99M EXAMETAZIME, DX, PER STUDY DOSE, UP TO 25 MCI
San Antonio, TX
See all hospitals reporting RC 636 →Price type
Santa Rosa Hospital - Westover Hills’s median price of $312 is 429% above the median hospital's median price ($59), higher than 95% of the 1,987 hospitals reporting RC 636. The highlighted bar is where this hospital falls; shaded is the middle 50% of hospitals.
Negotiated rates from the hospital’s own file: 12 payers, 37 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 mm fee schedule · outpatient | $180.27 | $457.93 | $1.31 – $1,948 |
| 2 | UnitedHealthcare all payer fee schedule · outpatient | $215.11 | $511.43 | $0.93 – $2,075 |
| 3 | Aetna chip km percent of total billed charges · outpatientfrom % of charges | $101.09 | $621.36 | $1.10 – $4,695 |
| 4 | Aetna star km percent of total billed charges · outpatientfrom % of charges | $101.09 | $621.36 | $1.10 – $4,695 |
| 5 | Bcbs Tx star chip km percent of total billed charges · outpatientfrom % of charges | $101.09 | $621.36 | $1.10 – $4,695 |
| 6 | Devoted mm percent of total billed charges · outpatientfrom % of charges | $316.00 | $622.89 | $5.00 – $3,269 |
| 7 | UnitedHealthcare chip km percent of total billed charges · outpatientfrom % of charges | $165.42 | $1,017 | $1.80 – $7,683 |
| 8 | UnitedHealthcare star km percent of total billed charges · outpatientfrom % of charges | $165.42 | $1,017 | $1.80 – $7,683 |
| 9 | UnitedHealthcare star plus km percent of total billed charges · outpatientfrom % of charges | $165.42 | $1,017 | $1.80 – $7,683 |
| 10 | Bcbs Tx mm fee schedule · outpatient | $972.65 | $1,055 | $21.72 – $1,948 |
| 11 | Humana gold choice mm fee schedule · outpatient | $972.65 | $1,055 | $21.72 – $1,948 |
| 12 | Humana gold plus mm fee schedule · outpatient | $972.65 | $1,055 | $21.72 – $1,948 |
| 13 | Molina medicare adv mm fee schedule · outpatient | $972.65 | $1,055 | $21.72 – $1,948 |
| 14 | UnitedHealthcare mm fee schedule · outpatient | $972.65 | $1,055 | $21.72 – $1,948 |
| 15 | WellCare mm fee schedule · outpatient | $972.65 | $1,055 | $21.72 – $1,948 |
| 16 | Devoted mm fee schedule · outpatient | $1,050 | $1,140 | $23.46 – $2,104 |
| 17 | UnitedHealthcare all payer percent of total billed charges · outpatientfrom % of charges | $194.10 | $1,475 | $3.00 – $12,806 |
| 18 | Molina chip km percent of total billed charges · outpatientfrom % of charges | $275.70 | $1,695 | $3.00 – $12,806 |
| 19 | Molina star plus km percent of total billed charges · outpatientfrom % of charges | $275.70 | $1,695 | $3.00 – $12,806 |
| 20 | Cigna new business percent of total billed charges · outpatientfrom % of charges | $239.39 | $1,819 | $3.70 – $15,794 |
| 21 | Humana choicecare fee schedule · outpatient | $235.25 | $2,122 | $1.57 – $13,603 |
| 22 | Bcbs Tx blue advantangehmo fee schedule · outpatient | $426.53 | $2,405 | $1.72 – $15,113 |
| 23 | First Health hmo percent of total billed charges · outpatientfrom % of charges | $329.97 | $2,507 | $5.10 – $21,770 |
| 24 | Healthcare Highways ppo percent of total billed charges · outpatientfrom % of charges | $413.55 | $2,542 | $4.50 – $19,209 |
| 25 | Cigna ppo percent of total billed charges · outpatientfrom % of charges | $355.85 | $2,703 | $5.50 – $23,477 |
Last updated: Jan 13, 2026
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