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
CT Pelvis C+ Matrl
Lebanon, NH
See all hospitals reporting CPT 72193 →Price type
Alice_peck_day_memorial_hospital’s median price of $1.4k is 201% above the median hospital's median price ($469), higher than 82% of the 2,597 hospitals reporting CPT 72193. The highlighted bar is where this hospital falls; shaded is the middle 50% of hospitals.
Negotiated rates from the hospital’s own file: 7 payers, 16 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 | Ambetter nh healthy families ambetter fee schedule · outpatient | $30.80 | $30.80 | $30.80 – $30.80 |
| 2 | Cigna cigna ppo per diem · outpatient | $784.00 | $784.00 | $784.00 – $784.00 |
| 3 | Cigna cigna hmo/pos per diem · outpatient | $832.00 | $832.00 | $832.00 – $832.00 |
| 4 | Anthem anthem bcbs medicare advantage percent of total billed charges · outpatientfrom % of charges | $1,059 | $1,059 | $1,059 – $1,059 |
| 5 | Blue Cross Blue Shield anthem bcbs individual qhp exchange pathway percent of total billed charges · outpatientfrom % of charges | $1,059 | $1,059 | $1,059 – $1,059 |
| 6 | Blue Cross Blue Shield anthem hmo/pos/ppo fee schedule · outpatient | $1,400 | $1,400 | $1,400 – $1,400 |
| 7 | Blue Cross Blue Shield anthem bcbs shop qhp exchange pathway percent of total billed charges · outpatientfrom % of charges | $1,482 | $1,482 | $1,482 – $1,482 |
| 8 | Blue Cross Blue Shield bcbs medicare advantage percent of total billed charges · outpatientfrom % of charges | $1,510 | $1,510 | $1,510 – $1,510 |
| 9 | UnitedHealthcare uhc mcr percent of total billed charges · outpatientfrom % of charges | $1,542 | $1,542 | $1,542 – $1,542 |
| 10 | UnitedHealthcare united healthcare percent of total billed charges · outpatientfrom % of charges | $1,542 | $1,542 | $1,542 – $1,542 |
| 11 | Blue Cross Blue Shield bcbs vt tvhp & managed care percent of total billed charges · outpatientfrom % of charges | $1,730 | $1,730 | $1,730 – $1,730 |
| 12 | Cigna cigna managed care percent of total billed charges · outpatientfrom % of charges | $1,751 | $1,751 | $1,751 – $1,751 |
| 13 | Blue Cross Blue Shield bcbs vt non managed care percent of total billed charges · outpatientfrom % of charges | $1,835 | $1,835 | $1,835 – $1,835 |
| 14 | Blue Cross Blue Shield 85% of billed percent of total billed charges · outpatientfrom % of charges | $1,905 | $1,905 | $1,905 – $1,905 |
| 15 | Aetna aetna percent of total billed charges · outpatientfrom % of charges | $1,927 | $1,927 | $1,927 – $1,927 |
| 16 | Humana humana medicare advantage percent of total billed charges · outpatientfrom % of charges | $2,227 | $2,227 | $2,227 – $2,227 |
Last updated: Jan 1, 2026
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