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 COMP
SPRINGVILLE, NY
See all hospitals reporting CPT 10121 →Price type
Bertrand Chaffee Hospital’s median price of $249 is 86% below the median hospital's median price ($1.8k), higher than 5% of the 2,260 hospitals reporting CPT 10121. 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, 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 | Medicare medicare fee schedule · both | $172.15 | $172.15 | $172.15 – $172.15 |
| 2 | Tricare tricare east reg fee schedule · both | $172.15 | $172.15 | $172.15 – $172.15 |
| 3 | Tricare tricare north region 1 fee schedule · both | $172.15 | $172.15 | $172.15 – $172.15 |
| 4 | Aetna aetna medicare fee schedule · both | $249.40 | $249.40 | $249.40 – $249.40 |
| 5 | Cigna cigna fee schedule · both | $249.40 | $249.40 | $249.40 – $249.40 |
| 6 | Humana humana gold fee schedule · both | $249.40 | $249.40 | $249.40 – $249.40 |
| 7 | Optum va optum community care fee schedule · both | $249.40 | $249.40 | $249.40 – $249.40 |
| 8 | Tricare wps tricare for life fee schedule · both | $249.40 | $249.40 | $249.40 – $249.40 |
| 9 | UnitedHealthcare aarp/united healthcare fee schedule · both | $249.40 | $249.40 | $249.40 – $249.40 |
| 10 | WellCare wellcare fee schedule · both | $249.40 | $249.40 | $249.40 – $249.40 |
| 11 | Blue Cross Blue Shield bc of wny hmo fee schedule · both | $279.41 | $279.41 | $218.40 – $340.42 |
| 12 | Blue Cross Blue Shield blue cross freedom blue fee schedule · both | $322.82 | $322.82 | $322.82 – $322.82 |
| 13 | Blue Cross Blue Shield bc of wny ppo fee schedule · both | $425.52 | $356.48 | $218.40 – $425.52 |
| 14 | Blue Cross Blue Shield wny bcbs essential plan fee schedule · both | $425.52 | $356.48 | $218.40 – $425.52 |
| 15 | Aetna aetna ins. percent of total billed charges · bothfrom % of charges | $658.43 | $658.43 | $272.85 – $1,044 |
| 16 | Cigna cigna commercial percent of total billed charges · bothfrom % of charges | $658.43 | $658.43 | $272.85 – $1,044 |
Last updated: Oct 1, 2026
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