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
Repair Intermediate N/H/F/Xtrnl Gent 2.5cm/<
Utica, NY
See all hospitals reporting CPT 12041 →Price type
MVHS, Inc.’s median price of $51 is 89% below the median hospital's median price ($486), higher than 0% of the 2,473 hospitals reporting CPT 12041. The highlighted bar is where this hospital falls; shaded is the middle 50% of hospitals.
Negotiated rates from the hospital’s own file: 12 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.
Filter by billing methodology
Filter by billing class
| # | |||||||
|---|---|---|---|---|---|---|---|
| 1 | Excellus excellus bcbs medicaid hmo fee schedule · outpatient | $3 | $3 | — | — | — | $3 – $3 |
| 2 | Medical Mutual worker's compensation and no fault fee schedule · outpatient | $19 | $19 | — | — | — | $19 – $19 |
| 3 | UnitedHealthcare uhc medicare advantage percent of total billed charges · inpatientfrom % of charges | $30 | $30 | — | — | — | $30 – $30 |
| 4 | Humana humana military percent of total billed charges · inpatientfrom % of charges | $51 | $51 | — | — | — | $51 – $51 |
| 5 | Tricare humana military percent of total billed charges · inpatientfrom % of charges | $51 | $51 | — | — | — | $51 – $51 |
| 6 | Aetna aetna medicare advantage fee schedule · both | $62 | $62 | — | — | — | $62 – $62 |
| 7 | Medicare medicare fee schedule · both | $62 | $62 | — | — | — | $62 – $62 |
| 8 | WellCare wellcare fee schedule · both | $64 | $64 | — | — | — | $64 – $64 |
| 9 | Humana choicecare fee schedule · both | $68 | $68 | — | — | — | $68 – $68 |
| 10 | Humana humana medicare advantage fee schedule · both | $68 | $68 | — | — | — | $68 – $68 |
| 11 | Blue Cross Blue Shield excellus bcbs federal fee schedule · both | $85 | $85 | — | — | — | $85 – $85 |
| 12 | UnitedHealthcare uhc commercial per diem · inpatient | $86 | $86 | — | — | — | $86 – $86 |
| 13 | UnitedHealthcare uhc commercial per diem · outpatient | $86 | $86 | — | — | — | $86 – $86 |
| 14 | Cigna mvp hmo/ppo fee schedule · both | $96 | $96 | — | — | — | $96 – $96 |
| 15 | UnitedHealthcare uhc empire plan fee schedule · outpatient | $101 | $101 | $41 | 40% | — | $61 – $142 |
| 16 | UnitedHealthcare uhc empire plan percent of total billed charges · inpatientfrom % of charges | $769 | $769 | — | — | — | $769 – $769 |
| 17 | Humana humana military other · outpatient | $791 | $791 | — | — | — | $791 – $791 |
| 18 | Tricare humana military other · outpatient | $791 | $791 | — | — | — | $791 – $791 |
| 19 | Excellus excellus bcbs medicare advantage other · outpatient | $884 | $884 | — | — | — | $884 – $884 |
| 20 | Humana humana medicare advantage other · outpatient | $884 | $884 | — | — | — | $884 – $884 |
| 21 | Medicare medicare other · outpatient | $884 | $884 | — | — | — | $884 – $884 |
| 22 | Optum vaccn optum other · outpatient | $884 | $884 | — | — | — | $884 – $884 |
| 23 | UnitedHealthcare uhc medicare advantage other · outpatient | $893 | $893 | — | — | — | $893 – $893 |
| 24 | Aetna aetna medicare advantage other · outpatient | $902 | $902 | — | — | — | $902 – $902 |
| 25 | WellCare wellcare medicare advantage other · outpatient | $910 | $910 | — | — | — | $910 – $910 |
Last updated: Aug 7, 2026
See Intermediate wound repair, hands/feet/neck/genitals, up to 2.5 cm pricing across every hospital in the network reporting it, or ask Claude or any MCP client directly — see how to connect.