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
Lebanon, NH
See all hospitals reporting CPT 10121 →Price type
Mary Hitchcock Memorial Hospital’s median price of $864 is 52% below the median hospital's median price ($1.8k), higher than 19% 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: 10 payers, 103 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 | UnitedHealthcare uhc - va community care network - dhps professional · fee schedule · outpatient | $221.04 | $221.04 | $180.90 – $261.17 |
| 2 | Amerihealth Caritas amerihealth caritas - nh managed medicaid professional · percent of total billed charges · outpatientfrom % of charges | $222.18 | $222.18 | $222.18 – $222.18 |
| 3 | Amerihealth Caritas amerihealth caritas - nh managed medicaid professional · fee schedule · outpatient | $325.27 | $325.27 | $325.27 – $325.27 |
| 4 | Amerihealth Caritas amerihealth caritas - nh managed medicaid - dhp professional · fee schedule · outpatient | $345.08 | $345.08 | $345.08 – $345.08 |
| 5 | Amerihealth Caritas amerihealth caritas - nh managed medicaid facility · percent of total billed charges · outpatientfrom % of charges | $385.90 | $385.90 | $385.90 – $385.90 |
| 6 | Ambetter ambetter commercial - exchange - dhps professional · fee schedule · outpatient | $419.43 | $419.43 | $343.27 – $495.59 |
| 7 | Anthem anthem - medicare advantage - dhp professional · fee schedule · outpatient | $452.20 | $436.15 | $144.72 – $695.46 |
| 8 | Bcbs Vt bcbs of vermont - medicare advantage - dhp professional · fee schedule · outpatient | $452.20 | $436.15 | $144.72 – $695.46 |
| 9 | UnitedHealthcare uhc - medicare advantage - dhp professional · fee schedule · outpatient | $452.20 | $436.15 | $144.72 – $695.46 |
| 10 | UnitedHealthcare uhc - va community care network - dhpn professional · fee schedule · outpatient | $452.20 | $436.15 | $144.72 – $695.46 |
| 11 | Aetna aetna medicare advantage - dhp professional · fee schedule · outpatient | $465.76 | $449.23 | $149.06 – $716.32 |
| 12 | Cigna cigna medicare advantage - dhp professional · fee schedule · outpatient | $465.76 | $449.23 | $149.06 – $716.32 |
| 13 | WellCare wellcare - medicare advantage - dhp professional · fee schedule · outpatient | $470.28 | $453.58 | $150.50 – $723.27 |
| 14 | Ambetter ambetter commercial - exchange behavioral health - dhp professional · fee schedule · outpatient | $474.81 | $457.95 | $151.95 – $730.23 |
| 15 | Anthem anthem shop - exchange - dhp professional · fee schedule · outpatient | $515.75 | $515.75 | $422.08 – $609.41 |
| 16 | Anthem anthem indiv qhp - exchange - dhp professional · fee schedule · outpatient | $533.07 | $533.07 | $436.26 – $629.88 |
| 17 | Bcbs Vt bcbs of vermont - the vermont health plan professional · fee schedule · outpatient | $656.64 | $556.23 | $149.06 – $729.53 |
| 18 | Cigna cigna ppo - dhp professional · fee schedule · outpatient | $558.37 | $558.37 | $451.92 – $664.82 |
| 19 | Anthem anthem shop - exchange professional · fee schedule · outpatient | $569.83 | $569.83 | $463.17 – $676.48 |
| 20 | Cigna cigna hmo-pos professional · fee schedule · outpatient | $574.58 | $574.58 | $465.70 – $683.46 |
| 21 | Anthem anthem indiv qhp - exchange professional · fee schedule · outpatient | $589.95 | $589.95 | $479.52 – $700.37 |
| 22 | Anthem anthem ppo - dhp professional · fee schedule · outpatient | $590.37 | $590.37 | $483.15 – $697.59 |
| 23 | Anthem anthem hmo/pos; individual non qhp on or off exch; shop off exch professional · fee schedule · outpatient | $633.15 | $633.15 | $514.64 – $751.65 |
| 24 | Anthem anthem ppo professional · fee schedule · outpatient | $633.15 | $633.15 | $514.64 – $751.65 |
| 25 | Cigna cigna hmo-pos - dhp professional · fee schedule · outpatient | $635.97 | $635.97 | $514.72 – $757.21 |
Last updated: Jan 1, 2026
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