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
INC&RMVL FB SUBQ TISS SMPL
Austin, TX
See all hospitals reporting CPT 10120 →Price type
Ascension Seton’s median price of $383 is 19% below the median hospital's median price ($472), higher than 27% of the 2,522 hospitals reporting CPT 10120. 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, 35 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 4127_blue cross blue shield bav exchange 20250101 fee schedule · outpatient | $76.92 | $76.92 | $76.92 – $76.92 |
| 2 | Blue Cross Blue Shield 4168_blue cross chip (chi,dcn) outpatient 20241201 fee schedule · outpatient | $86.38 | $86.38 | $86.38 – $86.38 |
| 3 | Blue Cross Blue Shield 4168_blue cross chip/star kids (chi,dcn) outpatient 20241201 fee schedule · outpatient | $86.38 | $86.38 | $86.38 – $86.38 |
| 4 | Blue Cross Blue Shield 4175_blue cross chip (sw) outpatient 20241201 fee schedule · outpatient | $86.38 | $86.38 | $86.38 – $86.38 |
| 5 | Blue Cross Blue Shield 4175_blue cross chip/star kids (sw) outpatient 20241201 fee schedule · outpatient | $86.38 | $86.38 | $86.38 – $86.38 |
| 6 | Blue Cross Blue Shield 4219_chirp blue cross star (chi,dcn) outpatient 20241201 fee schedule · outpatient | $86.38 | $86.38 | $86.38 – $86.38 |
| 7 | Blue Cross Blue Shield 4226_chirp blue cross star (sw) outpatient 20241201 fee schedule · outpatient | $86.38 | $86.38 | $86.38 – $86.38 |
| 8 | Blue Cross Blue Shield 5003_blue cross star kids (chi,dcn) outpatient 20241201 fee schedule · outpatient | $86.38 | $86.38 | $86.38 – $86.38 |
| 9 | Blue Cross Blue Shield 5017_blue cross star kids (sw) outpatient 20241201 fee schedule · outpatient | $86.38 | $86.38 | $86.38 – $86.38 |
| 10 | UnitedHealthcare 4253_chirp uhc star (chi,dcn) outpatient 20241201 fee schedule · outpatient | $86.38 | $86.38 | $86.38 – $86.38 |
| 11 | UnitedHealthcare 4260_chirp uhc star (sw) outpatient 20241201 fee schedule · outpatient | $86.38 | $86.38 | $86.38 – $86.38 |
| 12 | UnitedHealthcare 4264_chirp uhc star plus (chi,dcn) outpatient 20241201 fee schedule · outpatient | $86.38 | $86.38 | $86.38 – $86.38 |
| 13 | UnitedHealthcare 4271_chirp uhc star plus (sw) outpatient 20241201 fee schedule · outpatient | $86.38 | $86.38 | $86.38 – $86.38 |
| 14 | UnitedHealthcare 4311_uhc star kids (chi,dcn) outpatient 20241201 fee schedule · outpatient | $86.38 | $86.38 | $86.38 – $86.38 |
| 15 | UnitedHealthcare 4318_uhc star kids (sw) outpatient 20241201 fee schedule · outpatient | $86.38 | $86.38 | $86.38 – $86.38 |
| 16 | Blue Cross Blue Shield 4440_blue cross blue shield hpn 20250501 fee schedule · outpatient | $102.56 | $102.56 | $102.56 – $102.56 |
| 17 | Blue Cross Blue Shield 4497_blue cross blue shield hpn (dell, williamson,hays) 20250501 fee schedule · outpatient | $102.56 | $102.56 | $102.56 – $102.56 |
| 18 | Blue Cross Blue Shield 4095_blue cross blue shield hmo essentials 20250101 fee schedule · outpatient | $110.03 | $110.03 | $110.03 – $110.03 |
| 19 | Blue Cross Blue Shield 4094_blue cross blue shield ppo 20250101 fee schedule · outpatient | $124.99 | $124.99 | $124.99 – $124.99 |
| 20 | Tricare 1229_tricare cah outpatient 20170101 fee schedule · outpatient | $217.92 | $217.92 | $217.92 – $217.92 |
| 21 | Aetna 4659_medicare advantage aetna inpatient 20251001 other · inpatient | $387.18 | $387.18 | $387.18 – $387.18 |
| 22 | Aetna 4749_medicare advantage aetna outpatient 20250811 other · outpatient | $387.18 | $387.18 | $387.18 – $387.18 |
| 23 | Devoted 4684_medicare advantage devoted health inpatient 20251001 other · inpatient | $387.18 | $387.18 | $387.18 – $387.18 |
| 24 | Devoted 4918_medicare advantage devoted health outpatient 20250811 other · outpatient | $387.18 | $387.18 | $387.18 – $387.18 |
| 25 | Humana 4661_medicare advantage humana inpatient (aus,hay,nw,sw) 20251001 other · inpatient | $387.18 | $387.18 | $387.18 – $387.18 |
Last updated: Jan 1, 2026
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