Repair of a superficial wound, 7.6 to 12.5 cm at MVHS, Inc.

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.

Model: claude-haiku-5-5
Provider: anthropic
API: message_batches
Reasoning effort: low
Max output tokens: 4096
Prompt version (hash): 444523875572
Generated: October 20, 2026

Original text from hospital filings

HC Repair Sup. 7.6-12.5cm

Utica, NY

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How this price compares nationally

MVHS, Inc.’s median price of $302 is 5% above the median hospital's median price ($287), higher than 52% of the 2,435 hospitals reporting CPT 12004. The highlighted bar is where this hospital falls; shaded is the middle 50% of hospitals.

Payers reporting CPT 12004 at MVHS, Inc.

Negotiated rates from the hospital’s own file: 12 payers, 43 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 medicare advantage percent of total billed charges · inpatientfrom % of charges	$15	$15	—	—	—	$15 – $15
2	Humana humana military percent of total billed charges · inpatientfrom % of charges	$26	$26	—	—	—	$26 – $26
3	Tricare humana military percent of total billed charges · inpatientfrom % of charges	$26	$26	—	—	—	$26 – $26
4	WellCare wellcare fee schedule · outpatient	$30	$30	—	—	—	$30 – $30
5	Aetna aetna medicare advantage fee schedule · both	$34	$34	—	—	—	$34 – $34
6	WellCare wellcare fee schedule · both	$35	$35	—	—	—	$35 – $35
7	WellCare wellcare fee schedule · inpatient	$35	$35	—	—	—	$35 – $35
8	Humana choicecare fee schedule · both	$48	$48	$14	29%	—	$34 – $61
9	Humana humana medicare advantage fee schedule · both	$48	$48	$14	29%	—	$34 – $61
10	UnitedHealthcare uhc medicare advantage percent of total billed charges · bothfrom % of charges	$54	$54	—	—	—	$54 – $54
11	Medicare medicare fee schedule · both	$55	$55	$21	39%	—	$34 – $77
12	Humana humana military fee schedule · both	$58	$58	—	—	—	$58 – $58
13	Tricare humana military fee schedule · both	$58	$58	—	—	—	$58 – $58
14	Blue Cross Blue Shield excellus bcbs federal fee schedule · both	$60	$60	$17	29%	—	$42 – $77
15	Cigna mvp hmo/ppo fee schedule · both	$68	$68	$20	29%	—	$48 – $87
16	UnitedHealthcare uhc commercial per diem · inpatient	$86	$86	—	—	—	$86 – $86
17	UnitedHealthcare uhc empire plan fee schedule · outpatient	$151	$151	—	—	—	$151 – $151
18	Excellus excellus bcbs medicaid percent of total billed charges · outpatientfrom % of charges	$264	$261	$5	2%	2–20	$251 – $264
19	Medical Mutual worker's compensation and no fault fee schedule · outpatient	$302	$302	—	—	—	$302 – $302
20	Humana humana military other · outpatient	$351	$351	$128	36%	—	$223 – $479
21	Tricare humana military other · outpatient	$351	$351	$128	36%	—	$223 – $479
22	Excellus excellus bcbs medicare advantage other · outpatient	$386	$386	$135	35%	—	$250 – $521
23	Humana humana medicare advantage other · outpatient	$386	$386	$135	35%	—	$250 – $521
24	Medicare medicare other · outpatient	$386	$386	$135	35%	—	$250 – $521
25	Optum vaccn optum other · outpatient	$386	$386	$135	35%	—	$250 – $521

Page 1 of 2 · 43 rates

Last updated: Aug 7, 2026

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