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 Diethylene-triamine-pentaacetate
Springfield, VT
See all hospitals reporting HCPCS A4641 →Price type
Springfield Hospital’s median price of $675 is 91% above the median hospital's median price ($353), higher than 68% of the 577 hospitals reporting HCPCS A4641. 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, 11 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 anthem exchange fee schedule · outpatient | $321 | $321 | — | — | — | $321 – $321 |
| 2 | Anthem medicare advantage fee schedule · outpatient | $321 | $321 | — | — | — | $321 – $321 |
| 3 | UnitedHealthcare medicare advantage fee schedule · outpatient | $321 | $321 | — | — | — | $321 – $321 |
| 4 | WellCare medicare advantage fee schedule · outpatient | $331 | $331 | — | — | — | $331 – $331 |
| 5 | Anthem commercial percent of total billed charges · outpatientfrom % of charges | $566 | $566 | — | — | — | $566 – $566 |
| 6 | Cigna commercial percent of total billed charges · outpatientfrom % of charges | $593 | $593 | — | — | — | $593 – $593 |
| 7 | MultiPlan commercial percent of total billed charges · outpatientfrom % of charges | $701 | $701 | — | — | — | $701 – $701 |
| 8 | UnitedHealthcare commercial percent of total billed charges · outpatientfrom % of charges | $761 | $761 | — | — | — | $761 – $761 |
| 9 | Aetna commercial percent of total billed charges · outpatientfrom % of charges | $803 | $803 | — | — | — | $803 – $803 |
| 10 | Blue Cross Blue Shield medicare advantage percent of total billed charges · outpatientfrom % of charges | $845 | $845 | — | — | — | $845 – $845 |
| 11 | Cigna medicare advantage percent of total billed charges · outpatientfrom % of charges | $879 | $879 | — | — | — | $879 – $879 |
Last updated: Aug 27, 2026
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