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
HC Dest B/Pre-M Les 15 &>
Utica, NY
See all hospitals reporting CPT 17004 →Price type
MVHS, Inc.’s median price of $1.3k is 187% above the median hospital's median price ($452), higher than 84% of the 1,860 hospitals reporting CPT 17004. 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, 13 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 commercial per diem · inpatient | $86 | $86 | — | — | — | $86 – $86 |
| 2 | UnitedHealthcare uhc commercial per diem · outpatient | $86 | $86 | — | — | — | $86 – $86 |
| 3 | UnitedHealthcare uhc empire plan fee schedule · outpatient | $226 | $226 | — | — | — | $226 – $226 |
| 4 | UnitedHealthcare uhc empire plan percent of total billed charges · inpatientfrom % of charges | $1.1k | $1.1k | — | — | — | $1.1k – $1.1k |
| 5 | Cigna mvp and cigna commercial other · outpatient | $1.5k | $1.5k | — | — | — | $1.5k – $1.5k |
| 6 | Aetna aetna commercial percent of total billed charges · bothfrom % of charges | $1.7k | $1.7k | — | — | — | $1.7k – $1.7k |
| 7 | Humana humana hmo/pos percent of total billed charges · inpatientfrom % of charges | $1.9k | $1.9k | — | — | — | $1.9k – $1.9k |
| 8 | Bcbs Ny excellus bcbs indemnity percent of total billed charges · bothfrom % of charges | $1.9k | $1.9k | — | — | — | $1.9k – $1.9k |
| 9 | Blue Cross Blue Shield excellus bcbs hmo/ppo percent of total billed charges · bothfrom % of charges | $1.9k | $1.9k | — | — | — | $1.9k – $1.9k |
| 10 | Excellus excellus bcbs hmo/ppo percent of total billed charges · bothfrom % of charges | $1.9k | $1.9k | — | — | — | $1.9k – $1.9k |
| 11 | Excellus excellus bcbs indemnity percent of total billed charges · bothfrom % of charges | $1.9k | $1.9k | — | — | — | $1.9k – $1.9k |
| 12 | Cigna mvp and cigna commercial percent of total billed charges · inpatientfrom % of charges | $2.0k | $2.0k | — | — | — | $2.0k – $2.0k |
| 13 | Humana humana hmo/pos percent of total billed charges · outpatientfrom % of charges | $2.1k | $2.1k | — | — | — | $2.1k – $2.1k |
Last updated: Aug 7, 2026
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