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
Insj/rplc car modulj pls gn
Lebanon, NH
See all hospitals reporting CPT 0409T →Price type
Mary Hitchcock Memorial Hospital’s median price of $18.3k is 19% below the median hospital's median price ($22.5k), higher than 25% of the 1,319 hospitals reporting CPT 0409T. 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, 20 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 | Aetna aetna medicare advantage - dhp professional · fee schedule · outpatient | $369.90 | $369.90 | $369.90 – $369.90 |
| 2 | Bcbs Vt bcbs of vermont - the vermont health plan professional · fee schedule · outpatient | $369.90 | $369.90 | $369.90 – $369.90 |
| 3 | UnitedHealthcare uhc - freedom plan - dhp professional · fee schedule · outpatient | $3,400 | $3,400 | $3,400 – $3,400 |
| 4 | UnitedHealthcare uhc - tiered freedom plan professional · fee schedule · outpatient | $3,400 | $3,400 | $3,400 – $3,400 |
| 5 | UnitedHealthcare uhc - hmo/pos/ppo - dhp professional · fee schedule · outpatient | $7,966 | $7,966 | $7,966 – $7,966 |
| 6 | UnitedHealthcare uhc - hmo/pos/ppo facility · case rate · outpatient | $12,143 | $12,143 | $12,143 – $12,143 |
| 7 | Anthem anthem - medicare advantage facility · case rate · outpatient | $25,119 | $25,119 | $25,119 – $25,119 |
| 8 | Bcbs Vt bcbs of vermont - medicare advantage facility · case rate · outpatient | $25,119 | $25,119 | $25,119 – $25,119 |
| 9 | UnitedHealthcare uhc - medicare advantage facility · case rate · outpatient | $25,119 | $25,119 | $25,119 – $25,119 |
| 10 | UnitedHealthcare uhc - va community care network facility · case rate · outpatient | $25,119 | $25,119 | $25,119 – $25,119 |
| 11 | Aetna aetna medicare advantage facility · case rate · outpatient | $25,872 | $25,872 | $25,872 – $25,872 |
| 12 | Cigna cigna medicare advantage facility · case rate · outpatient | $25,872 | $25,872 | $25,872 – $25,872 |
| 13 | WellCare wellcare - medicare advantage facility · case rate · outpatient | $26,124 | $26,124 | $26,124 – $26,124 |
| 14 | Ambetter ambetter commercial - exchange behavioral health facility · case rate · outpatient | $34,639 | $34,639 | $34,639 – $34,639 |
| 15 | Anthem anthem indiv qhp - exchange facility · case rate · outpatient | $38,585 | $38,585 | $38,585 – $38,585 |
| 16 | Ambetter ambetter commercial - exchange facility · case rate · outpatient | $54,041 | $54,041 | $54,041 – $54,041 |
| 17 | Anthem anthem shop - exchange facility · case rate · outpatient | $58,058 | $58,058 | $58,058 – $58,058 |
| 18 | Anthem anthem hmo/pos; individual non qhp on or off exch; shop off exch facility · case rate · outpatient | $90,594 | $90,594 | $90,594 – $90,594 |
| 19 | Anthem anthem - indemnity facility · case rate · outpatient | $97,735 | $97,735 | $97,735 – $97,735 |
| 20 | Anthem anthem ppo facility · case rate · outpatient | $97,735 | $97,735 | $97,735 – $97,735 |
Last updated: Jan 1, 2026
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