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
NM DOSE SM-153 LEXIDRONAM UP TO 150 MCI
Ulm, MN
See all hospitals reporting HCPCS A9604 →Price type
Allina Health Systems’s median price of $10.5k is 25% above the median hospital's median price ($8.4k), higher than 59% of the 1,379 hospitals reporting HCPCS A9604. The highlighted bar is where this hospital falls; shaded is the middle 50% of hospitals.
Negotiated rates from the hospital’s own file: 10 payers, 25 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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Filter by billing class
| # | |||||||
|---|---|---|---|---|---|---|---|
| 1 | Bcbs Mn bc pmap (n) facility · other · outpatient | $1.9k | $1.9k | — | — | — | $1.9k – $1.9k |
| 2 | Aetna allina aetna medicare (n) facility · fee schedule · outpatient | $3.0k | $3.0k | — | — | — | $3.0k – $3.0k |
| 3 | Medicare medicare (n) facility · fee schedule · outpatient | $3.2k | $3.2k | — | — | — | $3.2k – $3.2k |
| 4 | Ucare ucare pmap (abdmnorsuv) facility · percent of total billed charges · outpatientfrom % of charges | $4.1k | $4.1k | — | — | — | $4.1k – $4.1k |
| 5 | Bcbs Mn bc state health plan (n) facility · other · outpatient | $5.1k | $5.1k | — | — | — | $5.1k – $5.1k |
| 6 | Bcbs Mn bc premier(n) facility · other · outpatient | $6.5k | $6.5k | — | — | — | $6.5k – $6.5k |
| 7 | Medica medica pmap (n) facility · percent of total billed charges · outpatientfrom % of charges | $6.5k | $6.5k | — | — | — | $6.5k – $6.5k |
| 8 | Blue Cross Blue Shield bc aehp (n) facility · other · outpatient | $7.7k | $7.7k | — | — | — | $7.7k – $7.7k |
| 9 | Bcbs Mn bc high value/performance network (n) facility · other · outpatient | $8.2k | $8.2k | — | — | — | $8.2k – $8.2k |
| 10 | Medicaid medicaid ma (n) facility · other · outpatient | $9.0k | $9.0k | — | — | — | $9.0k – $9.0k |
| 11 | Medica medica medicare (r) facility · fee schedule · outpatient | $9.1k | $9.1k | — | — | — | $9.1k – $9.1k |
| 12 | Medica medica dual solutions (r) facility · percent of total billed charges · outpatientfrom % of charges | $9.2k | $9.2k | — | — | — | $9.2k – $9.2k |
| 13 | Blue Cross Blue Shield bc medicare (n) facility · fee schedule · outpatient | $9.6k | $9.6k | — | — | — | $9.6k – $9.6k |
| 14 | UnitedHealthcare united healthcare (nr) facility · percent of total billed charges · outpatientfrom % of charges | $10.3k | $10.3k | — | — | — | $10.3k – $10.3k |
| 15 | Aetna aetna elevate (n r) facility · percent of total billed charges · inpatientfrom % of charges | $12.6k | $12.6k | — | — | — | $12.6k – $12.6k |
| 16 | Aetna aetna elevate (n r) facility · percent of total billed charges · outpatientfrom % of charges | $12.7k | $12.7k | — | — | — | $12.7k – $12.7k |
| 17 | Aetna aetna performance (n r) facility · percent of total billed charges · inpatientfrom % of charges | $13.6k | $13.6k | — | — | — | $13.6k – $13.6k |
| 18 | Aetna aetna performance (n r) facility · percent of total billed charges · outpatientfrom % of charges | $13.7k | $13.7k | — | — | — | $13.7k – $13.7k |
| 19 | Medica medica ubh pmap (n) facility · percent of total billed charges · outpatientfrom % of charges | $16.4k | $16.4k | — | — | — | $16.4k – $16.4k |
| 20 | Cigna hpi cigna (n) facility · other · outpatient | $16.8k | $16.8k | — | — | — | $16.8k – $16.8k |
| 21 | First Health first health (abdmnosurv) facility · percent of total billed charges · inpatientfrom % of charges | $17.3k | $17.3k | — | — | — | $17.3k – $17.3k |
| 22 | First Health first health (abdmnosurv) facility · percent of total billed charges · outpatientfrom % of charges | $17.3k | $17.3k | — | — | — | $17.3k – $17.3k |
| 23 | Medica medica ubh (n) facility · percent of total billed charges · outpatientfrom % of charges | $17.3k | $17.3k | — | — | — | $17.3k – $17.3k |
| 24 | Aetna aetna direct/indirect network (n r) facility · percent of total billed charges · inpatientfrom % of charges | $17.4k | $17.4k | — | — | — | $17.4k – $17.4k |
| 25 | Aetna aetna direct/indirect network (n r) facility · percent of total billed charges · outpatientfrom % of charges | $17.6k | $17.6k | — | — | — | $17.6k – $17.6k |
Last updated: Jun 16, 2026
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