Diagnostic radiopharmaceutical, not otherwise classified at Holy Name

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.

Model: claude-haiku-5-5
Provider: anthropic
API: message_batches
Reasoning effort: low
Max output tokens: 4096
Prompt version (hash): 444523875572
Generated: October 20, 2026

Original text from hospital filings

I-123 MIBG, PER DOSE

Teaneck, NJ

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Pricing by billing methodology

Price type

How this price compares nationally

Holy Name’s median price of $29 is 92% below the median hospital's median price ($353), higher than 5% of the 577 hospitals reporting HCPCS A4641. The highlighted bar is where this hospital falls; shaded is the middle 50% of hospitals.

Payers reporting HCPCS A4641 at Holy Name

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	Aetna hmo/pos facility · other · outpatient	$0	$0	—	—	—	$0 – $0
2	Aetna qualified health plans facility · other · outpatient	$0	$0	—	—	—	$0 – $0
3	UnitedHealthcare medicaid facility · percent of total billed charges · outpatientfrom % of charges	$50	$50	$46	90%	—	$5 – $96
4	Aetna better health mcd/chip facility · percent of total billed charges · outpatientfrom % of charges	$53	$53	$48	90%	—	$5 – $101
5	Aetna medicare prime facility · percent of total billed charges · outpatientfrom % of charges	$57	$57	$52	90%	—	$6 – $109
6	Aetna golden medicare facility · percent of total billed charges · outpatientfrom % of charges	$70	$70	$63	90%	—	$7 – $133
7	Ambetter ambetter facility · percent of total billed charges · outpatientfrom % of charges	$79	$79	$71	90%	—	$8 – $150
8	Aetna whole health facility · percent of total billed charges · outpatientfrom % of charges	$102	$102	$92	90%	—	$10 – $194
9	First Health first health facility · percent of total billed charges · outpatientfrom % of charges	$107	$107	$97	90%	—	$10 – $204
10	Aetna worker's comp facility · percent of total billed charges · outpatientfrom % of charges	$114	$114	$103	90%	—	$11 – $216
11	Cigna hmo/pos facility · percent of total billed charges · outpatientfrom % of charges	$158	$158	$143	90%	—	$15 – $301
12	MultiPlan multiplan facility · percent of total billed charges · outpatientfrom % of charges	$205	$205	$185	90%	—	$20 – $391
13	MultiPlan worker's comp facility · percent of total billed charges · outpatientfrom % of charges	$268	$268	$242	90%	—	$26 – $511
14	MultiPlan auto accident medical facility · percent of total billed charges · outpatientfrom % of charges	$284	$284	$257	90%	—	$27 – $541
15	Blue Cross Blue Shield indemnity facility · percent of total billed charges · outpatientfrom % of charges	$293	$293	$265	90%	—	$28 – $557
16	Blue Cross Blue Shield managed facility · percent of total billed charges · outpatientfrom % of charges	$293	$293	$265	90%	—	$28 – $557
17	Blue Cross Blue Shield ppo facility · percent of total billed charges · outpatientfrom % of charges	$293	$293	$265	90%	—	$28 – $557
18	UnitedHealthcare uhc facility · other · outpatient	$3.7k	$3.7k	—	—	—	$3.7k – $3.7k

Last updated: Nov 10, 2025

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