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
TC99 PENTETATE AERO, DOSE-75MC
Duluth, MN
See all hospitals reporting HCPCS A9567 →Price type
Essentia Health Duluth’s median price of $64 is 50% below the median hospital's median price ($128), higher than 35% of the 1,475 hospitals reporting HCPCS A9567. The highlighted bar is where this hospital falls; shaded is the middle 50% of hospitals.
Negotiated rates from the hospital’s own file: 8 payers, 26 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 | Blue Cross Blue Shield bcbs mn facility · fee schedule · outpatient | $1 | $1 | — | — | — | $1 – $1 |
| 2 | Medica medicaid facility · percent of total billed charges · outpatientfrom % of charges | $46 | $46 | $22 | 47% | — | $24 – $68 |
| 3 | Healthpartners medicaid facility · percent of total billed charges · outpatientfrom % of charges | $56 | $56 | $26 | 47% | — | $29 – $82 |
| 4 | Blue Cross Blue Shield medicaid facility · percent of total billed charges · outpatientfrom % of charges | $58 | $58 | $27 | 47% | — | $31 – $85 |
| 5 | Blue Cross Blue Shield shp facility · percent of total billed charges · inpatientfrom % of charges | $58 | $58 | $27 | 47% | — | $31 – $85 |
| 6 | Blue Cross Blue Shield shp facility · percent of total billed charges · outpatientfrom % of charges | $58 | $58 | $27 | 47% | — | $31 – $85 |
| 7 | Sanford Health Plan commercia-ndpers facility · percent of total billed charges · inpatientfrom % of charges | $60 | $60 | $28 | 47% | — | $32 – $88 |
| 8 | Sanford Health Plan commercia-ndpers facility · percent of total billed charges · outpatientfrom % of charges | $60 | $60 | $28 | 47% | — | $32 – $88 |
| 9 | Blue Cross Blue Shield bcbs mn facility · percent of total billed charges · outpatientfrom % of charges | $63 | $63 | $30 | 47% | — | $33 – $92 |
| 10 | Sanford Health Plan commercial facility · percent of total billed charges · inpatientfrom % of charges | $63 | $63 | $30 | 47% | — | $33 – $93 |
| 11 | Sanford Health Plan commercial facility · percent of total billed charges · outpatientfrom % of charges | $63 | $63 | $30 | 47% | — | $33 – $93 |
| 12 | Medica commercial-fi facility · percent of total billed charges · outpatientfrom % of charges | $77 | $77 | $36 | 47% | — | $41 – $114 |
| 13 | Medica commercial-si facility · percent of total billed charges · outpatientfrom % of charges | $79 | $79 | $37 | 47% | — | $42 – $117 |
| 14 | Medica commercial facility · percent of total billed charges · outpatientfrom % of charges | $79 | $81 | $39 | 47% | — | $41 – $126 |
| 15 | Blue Cross Blue Shield medicaid facility · percent of total billed charges · inpatientfrom % of charges | $84 | $84 | $39 | 47% | — | $44 – $123 |
| 16 | Ucare commercial facility · percent of total billed charges · inpatientfrom % of charges | $92 | $92 | $43 | 47% | — | $49 – $135 |
| 17 | Ucare commercial facility · percent of total billed charges · outpatientfrom % of charges | $92 | $92 | $43 | 47% | — | $49 – $135 |
| 18 | Blue Cross Blue Shield bcbs mn facility · percent of total billed charges · inpatientfrom % of charges | $93 | $93 | $44 | 47% | — | $49 – $137 |
| 19 | Cigna commercial facility · percent of total billed charges · outpatientfrom % of charges | $100 | $100 | $47 | 47% | — | $53 – $147 |
| 20 | Healthpartners commercial facility · percent of total billed charges · outpatientfrom % of charges | $100 | $100 | $47 | 47% | — | $53 – $147 |
| 21 | Healthpartners shp facility · percent of total billed charges · outpatientfrom % of charges | $100 | $100 | $47 | 47% | — | $53 – $147 |
| 22 | UnitedHealthcare commercial facility · percent of total billed charges · outpatientfrom % of charges | $102 | $102 | $48 | 47% | — | $54 – $150 |
| 23 | Blue Cross Blue Shield commercial facility · percent of total billed charges · inpatientfrom % of charges | $106 | $106 | $50 | 47% | — | $56 – $156 |
| 24 | Blue Cross Blue Shield commercial facility · percent of total billed charges · outpatientfrom % of charges | $106 | $106 | $50 | 47% | — | $56 – $156 |
| 25 | Aetna commercial facility · percent of total billed charges · inpatientfrom % of charges | $119 | $119 | $56 | 47% | — | $63 – $175 |
Last updated: Jan 1, 2026
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