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 LEXIDRON THER
Troy, NY
See all hospitals reporting HCPCS A9604 →Price type
Samaritan Hospital’s median price of $31.6k is 277% above the median hospital's median price ($8.4k), higher than 91% 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: 15 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 | Anthem empire bcbs hmo epo ppo indemnity facility · fee schedule · both | $3.5k | $3.5k | — | — | — | $3.5k – $3.5k |
| 2 | Blue Cross Blue Shield empire bcbs hmo epo ppo indemnity facility · fee schedule · both | $3.5k | $3.5k | — | — | — | $3.5k – $3.5k |
| 3 | UnitedHealthcare empire bcbs hmo epo ppo indemnity facility · fee schedule · both | $3.5k | $3.5k | — | — | — | $3.5k – $3.5k |
| 4 | Wellmark empire bcbs hmo epo ppo indemnity facility · fee schedule · both | $3.5k | $3.5k | — | — | — | $3.5k – $3.5k |
| 5 | UnitedHealthcare uhc essential plan medicaid facility · percent of total billed charges · bothfrom % of charges | $23.0k | $23.0k | — | — | — | $23.0k – $23.0k |
| 6 | UnitedHealthcare united healthcare medicaid harp chip facility · percent of total billed charges · bothfrom % of charges | $23.0k | $23.0k | — | — | — | $23.0k – $23.0k |
| 7 | Blue Cross Blue Shield blue shield of ne new york hmo facility · percent of total billed charges · bothfrom % of charges | $31.6k | $31.6k | — | — | — | $31.6k – $31.6k |
| 8 | Blue Cross Blue Shield blue shield of ne new york ppo facility · percent of total billed charges · bothfrom % of charges | $31.6k | $31.6k | — | — | — | $31.6k – $31.6k |
| 9 | Carefirst blue shield of ne new york hmo facility · percent of total billed charges · bothfrom % of charges | $31.6k | $31.6k | — | — | — | $31.6k – $31.6k |
| 10 | Carefirst blue shield of ne new york ppo facility · percent of total billed charges · bothfrom % of charges | $31.6k | $31.6k | — | — | — | $31.6k – $31.6k |
| 11 | Excellus blue shield of ne new york ppo facility · percent of total billed charges · bothfrom % of charges | $31.6k | $31.6k | — | — | — | $31.6k – $31.6k |
| 12 | Highmark blue shield of ne new york ascend facility · percent of total billed charges · bothfrom % of charges | $31.6k | $31.6k | — | — | — | $31.6k – $31.6k |
| 13 | Highmark blue shield of ne new york hmo facility · percent of total billed charges · bothfrom % of charges | $31.6k | $31.6k | — | — | — | $31.6k – $31.6k |
| 14 | Highmark blue shield of ne new york ppo facility · percent of total billed charges · bothfrom % of charges | $31.6k | $31.6k | — | — | — | $31.6k – $31.6k |
| 15 | Premera blue shield of ne new york ppo facility · percent of total billed charges · bothfrom % of charges | $31.6k | $31.6k | — | — | — | $31.6k – $31.6k |
| 16 | Regence blue shield of ne new york ppo facility · percent of total billed charges · bothfrom % of charges | $31.6k | $31.6k | — | — | — | $31.6k – $31.6k |
| 17 | Wellmark blue shield of ne new york hmo facility · percent of total billed charges · bothfrom % of charges | $31.6k | $31.6k | — | — | — | $31.6k – $31.6k |
| 18 | Wellmark blue shield of ne new york ppo facility · percent of total billed charges · bothfrom % of charges | $31.6k | $31.6k | — | — | — | $31.6k – $31.6k |
| 19 | Aetna aetna facility · percent of total billed charges · bothfrom % of charges | $40.2k | $40.2k | — | — | — | $40.2k – $40.2k |
| 20 | Medical Mutual aetna facility · percent of total billed charges · bothfrom % of charges | $40.2k | $40.2k | — | — | — | $40.2k – $40.2k |
| 21 | First Health first health facility · percent of total billed charges · bothfrom % of charges | $46.0k | $46.0k | — | — | — | $46.0k – $46.0k |
| 22 | Cigna cigna facility · percent of total billed charges · bothfrom % of charges | $48.8k | $48.8k | — | — | — | $48.8k – $48.8k |
| 23 | MultiPlan beech street facility · percent of total billed charges · bothfrom % of charges | $51.7k | $51.7k | — | — | — | $51.7k – $51.7k |
| 24 | MultiPlan multiplan facility · percent of total billed charges · bothfrom % of charges | $51.7k | $51.7k | — | — | — | $51.7k – $51.7k |
| 25 | Phcs multiplan facility · percent of total billed charges · bothfrom % of charges | $51.7k | $51.7k | — | — | — | $51.7k – $51.7k |
Last updated: Mar 31, 2026
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