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
SM153 LEXIDRON TX 150MCI
SAN ANTONIO, TX
See all hospitals reporting HCPCS A9604 →Price type
Methodist Hospital’s median price of $17.6k is 111% above the median hospital's median price ($8.4k), higher than 76% of the 1,373 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: 9 payers, 36 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 | UnitedHealthcare allpayerappendix fee schedule · outpatient | $5.2k | $5.2k | — | — | — | $5.2k – $5.2k |
| 2 | UnitedHealthcare charter fee schedule · outpatient | $5.2k | $5.2k | — | — | — | $5.2k – $5.2k |
| 3 | UnitedHealthcare nexusaco fee schedule · outpatient | $5.2k | $5.2k | — | — | — | $5.2k – $5.2k |
| 4 | UnitedHealthcare smallgroup fee schedule · outpatient | $5.2k | $5.2k | — | — | — | $5.2k – $5.2k |
| 5 | First Health chip percent of total billed charges · outpatientfrom % of charges | $5.8k | $5.8k | — | — | — | $5.8k – $5.8k |
| 6 | First Health chipperinate percent of total billed charges · outpatientfrom % of charges | $5.8k | $5.8k | — | — | — | $5.8k – $5.8k |
| 7 | First Health mcdstar percent of total billed charges · outpatientfrom % of charges | $5.8k | $5.8k | — | — | — | $5.8k – $5.8k |
| 8 | Oscar broadnetworkhix percent of total billed charges · outpatientfrom % of charges | $9.7k | $9.7k | — | — | — | $9.7k – $9.7k |
| 9 | Oscar epo percent of total billed charges · outpatientfrom % of charges | $9.7k | $9.7k | — | — | — | $9.7k – $9.7k |
| 10 | Oscar pos percent of total billed charges · outpatientfrom % of charges | $9.7k | $9.7k | — | — | — | $9.7k – $9.7k |
| 11 | Oscar ppo percent of total billed charges · outpatientfrom % of charges | $9.7k | $9.7k | — | — | — | $9.7k – $9.7k |
| 12 | UnitedHealthcare optionsppo percent of total billed charges · outpatientfrom % of charges | $12.2k | $12.2k | — | — | — | $12.2k – $12.2k |
| 13 | Aetna qhphix percent of total billed charges · outpatientfrom % of charges | $12.8k | $12.8k | — | — | — | $12.8k – $12.8k |
| 14 | First Health hmo percent of total billed charges · outpatientfrom % of charges | $13.1k | $13.1k | — | — | — | $13.1k – $13.1k |
| 15 | Cigna comm percent of total billed charges · outpatientfrom % of charges | $14.1k | $14.1k | — | — | — | $14.1k – $14.1k |
| 16 | Blue Cross Blue Shield trad percent of total billed charges · outpatientfrom % of charges | $14.3k | $14.3k | — | — | — | $14.3k – $14.3k |
| 17 | Healthcare Highways narrownetwork percent of total billed charges · outpatientfrom % of charges | $15.0k | $15.0k | — | — | — | $15.0k – $15.0k |
| 18 | Aetna narrownetwork percent of total billed charges · outpatientfrom % of charges | $17.4k | $17.4k | — | — | — | $17.4k – $17.4k |
| 19 | Aetna newbusinessrates percent of total billed charges · outpatientfrom % of charges | $18.7k | $18.7k | — | — | — | $18.7k – $18.7k |
| 20 | Aetna commercialbasenetwork percent of total billed charges · outpatientfrom % of charges | $19.1k | $19.1k | — | — | — | $19.1k – $19.1k |
| 21 | First Health comm percent of total billed charges · outpatientfrom % of charges | $21.4k | $21.4k | — | — | — | $21.4k – $21.4k |
| 22 | Aetna oon percent of total billed charges · outpatientfrom % of charges | $22.4k | $22.4k | — | — | — | $22.4k – $22.4k |
| 23 | Aetna asa percent of total billed charges · outpatientfrom % of charges | $24.3k | $24.3k | — | — | — | $24.3k – $24.3k |
| 24 | Cigna newbusinessnetwork fee schedule · outpatient | $27.9k | $27.9k | — | — | — | $27.9k – $27.9k |
| 25 | Cigna hmo fee schedule · outpatient | $30.4k | $30.4k | — | — | — | $30.4k – $30.4k |
Last updated: May 1, 2026
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