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
Laps Surg Prst8ect Rpbic Rad W/Bi Pel Lymphadec
Utica, NY
See all hospitals reporting CPT 55869 →Price type
MVHS, Inc.’s median price of $122 is 99% below the median hospital's median price ($11.4k), higher than 0% of the 795 hospitals reporting CPT 55869. 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, 21 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 | Excellus excellus bcbs medicaid hmo fee schedule · outpatient | $10 | $10 | — | — | — | $10 – $10 |
| 2 | Medical Mutual worker's compensation and no fault fee schedule · outpatient | $122 | $122 | — | — | — | $122 – $122 |
| 3 | UnitedHealthcare uhc empire plan fee schedule · outpatient | $803 | $803 | — | — | — | $803 – $803 |
| 4 | UnitedHealthcare uhc medicare advantage percent of total billed charges · inpatientfrom % of charges | $895 | $895 | — | — | — | $895 – $895 |
| 5 | Humana humana military other · outpatient | $918 | $918 | — | — | — | $918 – $918 |
| 6 | Tricare humana military other · outpatient | $918 | $918 | — | — | — | $918 – $918 |
| 7 | Aetna aetna medicare advantage fee schedule · both | $1.3k | $1.3k | — | — | — | $1.3k – $1.3k |
| 8 | Medicare medicare fee schedule · both | $1.3k | $1.3k | — | — | — | $1.3k – $1.3k |
| 9 | WellCare wellcare fee schedule · both | $1.3k | $1.3k | — | — | — | $1.3k – $1.3k |
| 10 | Humana humana military percent of total billed charges · inpatientfrom % of charges | $1.5k | $1.5k | — | — | — | $1.5k – $1.5k |
| 11 | Tricare humana military percent of total billed charges · inpatientfrom % of charges | $1.5k | $1.5k | — | — | — | $1.5k – $1.5k |
| 12 | UnitedHealthcare uhc commercial case rate · outpatient | $2.6k | $2.6k | — | — | — | $2.6k – $2.6k |
| 13 | Excellus excellus bcbs medicare advantage other · outpatient | $13.3k | $13.3k | — | — | 1–10 | $13.3k – $13.3k |
| 14 | Humana humana medicare advantage other · outpatient | $13.3k | $13.3k | — | — | — | $13.3k – $13.3k |
| 15 | Medicare medicare other · outpatient | $13.3k | $13.3k | — | — | 1–10 | $13.3k – $13.3k |
| 16 | Optum vaccn optum other · outpatient | $13.3k | $13.3k | — | — | — | $13.3k – $13.3k |
| 17 | UnitedHealthcare uhc medicare advantage other · outpatient | $13.4k | $13.4k | — | — | — | $13.4k – $13.4k |
| 18 | Aetna aetna medicare advantage other · outpatient | $13.5k | $13.5k | — | — | — | $13.5k – $13.5k |
| 19 | WellCare wellcare medicare advantage other · outpatient | $13.7k | $13.7k | — | — | — | $13.7k – $13.7k |
| 20 | Excellus excellus bcbs hmo/ppo percent of total billed charges · outpatientfrom % of charges | $29.6k | $29.6k | — | — | 1–10 | $29.6k – $29.6k |
| 21 | Cigna mvp and cigna commercial other · outpatient | $38.1k | $38.1k | — | — | — | $38.1k – $38.1k |
Last updated: Aug 7, 2026
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