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
Sm 153 lexidronam
Low
$1.2k
Average
$15.8k
Median
$12.8k
High
$80.2k
Each payer's average rate across its hospitals, under the methodology and billing class chosen below.
61 payers; the 90th percentile is 7.0× the 10th. Each bar is a price range and its height is how many payers fall in it. Hover a bar, or a row in the ladder, for details.
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| # | ||||||||
|---|---|---|---|---|---|---|---|---|
| 1 | UnitedHealthcare fee schedule · outpatient · +21 other terms | 589 | $5.2k | $9.2k | $11.1k | 121% | — | $1 – $66.7k |
| 2 | Aetna fee schedule · outpatient · +19 other terms | 359 | $4.2k | $16.6k | $21.4k | 129% | — | $1 – $178.2k |
| 3 | Blue Cross Blue Shield fee schedule · outpatient · +22 other terms | 289 | $18.2k | $27.6k | $25.5k | 92% | — | $1 – $105.8k |
| 4 | Cigna fee schedule · outpatient · +19 other terms | 287 | $22.0k | $38.8k | $34.4k | 88% | — | $2.9k – $142.0k |
| 5 | Humana fee schedule · outpatient · +19 other terms | 279 | $4.4k | $23.5k | $41.9k | 178% | — | $1 – $147.0k |
| 6 | Molina fee schedule · outpatient · +18 other terms | 114 | $4.9k | $6.8k | $6.2k | 91% | — | $1 – $30.6k |
| 7 | Anthem facility · fee schedule · outpatient · +19 other terms | 109 | $4.8k | $25.3k | $165.7k | 655% | — | $248 – $2703.0k |
| 8 | WellCare fee schedule · outpatient · +12 other terms | 108 | $4.1k | $4.5k | $2.3k | 50% | — | $2.9k – $17.3k |
| 9 | Kaiser fee schedule · outpatient · +17 other terms | 68 | $4.7k | $16.2k | $24.8k | 153% | — | $1.3k – $135.7k |
| 10 | Devoted fee schedule · outpatient · +8 other terms | 60 | $3.3k | $3.6k | $670 | 19% | — | $2.9k – $4.8k |
| 11 | MultiPlan fee schedule · outpatient · +11 other terms | 55 | $26.1k | $25.9k | $9.6k | 37% | — | $4.3k – $42.3k |
| 12 | Ambetter facility · fee schedule · outpatient · +13 other terms | 54 | $5.7k | $7.6k | $3.9k | 51% | — | $3.3k – $30.4k |
| 13 | Optum fee schedule · outpatient · +13 other terms | 48 | $4.2k | $7.3k | $6.7k | 92% | — | $2.8k – $27.3k |
| 14 | Wellmark facility · fee schedule · both · +10 other terms | 38 | $4.7k | $10.8k | $10.5k | 97% | — | $3.5k – $48.1k |
| 15 | Excellus facility · fee schedule · both · +5 other terms | 37 | $4.7k | $12.7k | $10.6k | 83% | — | $3.6k – $48.1k |
| 16 | Oscar facility · fee schedule · outpatient · +11 other terms | 37 | $5.8k | $6.4k | $4.4k | 68% | — | $4.2k – $31.9k |
| 17 | Carefirst facility · fee schedule · both · +4 other terms | 36 | $4.7k | $12.2k | $11.0k | 91% | — | $3.6k – $48.1k |
| 18 | Caresource fee schedule · outpatient · +13 other terms | 36 | $4.9k | $43.7k | $29.7k | 68% | — | $1 – $66.7k |
| 19 | Highmark facility · fee schedule · both · +12 other terms | 36 | $4.7k | $11.9k | $11.3k | 94% | — | $3.6k – $48.1k |
| 20 | Premera facility · fee schedule · both · +7 other terms | 36 | $4.7k | $12.2k | $11.0k | 91% | — | $3.6k – $48.1k |
| 21 | Regence facility · fee schedule · both · +12 other terms | 36 | $4.7k | $12.2k | $11.0k | 91% | — | $3.6k – $48.1k |
| 22 | Medicare fee schedule · outpatient · +8 other terms | 26 | $3.1k | $4.0k | $3.4k | 85% | — | $3.0k – $17.3k |
| 23 | Medica facility · fee schedule · outpatient · +15 other terms | 25 | $4.3k | $6.1k | $5.2k | 85% | — | $3.3k – $32.3k |
| 24 | Clover fee schedule · outpatient · +4 other terms | 24 | $4.7k | $4.2k | $796 | 19% | — | $3.0k – $5.1k |
| 25 | Bcbs Tx fee schedule · outpatient · +3 other terms | 22 | $61.8k | $50.8k | $25.5k | 50% | — | $4.1k – $86.7k |
← Hospitals reporting HCPCS A9604 · Snapshot 20261111T120946Z-9134e7f7