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 US Art Dplx Leg Uni/Lmtd
Utica, NY
See all hospitals reporting CPT 93926 →Price type
MVHS, Inc.’s median price of $131 is 48% below the median hospital's median price ($251), higher than 23% of the 2,547 hospitals reporting CPT 93926. 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, 39 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 | Humana humana military percent of total billed charges · bothfrom % of charges | $26 | $26 | — | — | — | $26 – $26 |
| 2 | Tricare humana military percent of total billed charges · bothfrom % of charges | $26 | $26 | — | — | — | $26 – $26 |
| 3 | UnitedHealthcare uhc medicare advantage percent of total billed charges · bothfrom % of charges | $54 | $54 | $39 | 72% | — | $15 – $93 |
| 4 | Humana choicecare fee schedule · both | $76 | $76 | $55 | 72% | — | $21 – $131 |
| 5 | Humana humana medicare advantage fee schedule · both | $76 | $76 | $55 | 72% | — | $21 – $131 |
| 6 | Medicare medicare fee schedule · both | $77 | $77 | $56 | 72% | — | $22 – $133 |
| 7 | WellCare wellcare fee schedule · both | $80 | $80 | $57 | 72% | — | $22 – $137 |
| 8 | Excellus excellus bcbs medicaid fee schedule · outpatient | $94 | $94 | — | — | — | $94 – $94 |
| 9 | Excellus excellus bcbs medicaid hmo fee schedule · outpatient | $94 | $94 | — | — | — | $94 – $94 |
| 10 | Molina misc medicaid mco fee schedule · outpatient | $94 | $94 | — | — | — | $94 – $94 |
| 11 | UnitedHealthcare uhc essential plan fee schedule · outpatient | $94 | $94 | — | — | — | $94 – $94 |
| 12 | UnitedHealthcare uhc medicaid fee schedule · outpatient | $94 | $94 | — | — | — | $94 – $94 |
| 13 | WellCare hb mvhs wellcare medicaid fee schedule · outpatient | $94 | $94 | — | — | — | $94 – $94 |
| 14 | UnitedHealthcare uhc empire plan fee schedule · outpatient | $111 | $111 | — | — | — | $111 – $111 |
| 15 | Humana humana military fee schedule · both | $116 | $116 | — | — | — | $116 – $116 |
| 16 | Tricare humana military fee schedule · both | $116 | $116 | — | — | — | $116 – $116 |
| 17 | Humana humana military other · outpatient | $120 | $120 | — | — | — | $120 – $120 |
| 18 | Tricare humana military other · outpatient | $120 | $120 | — | — | — | $120 – $120 |
| 19 | Excellus excellus bcbs medicare advantage other · outpatient | $131 | $131 | — | — | — | $131 – $131 |
| 20 | Humana humana medicare advantage other · outpatient | $131 | $131 | — | — | — | $131 – $131 |
| 21 | Medicare medicare other · outpatient | $131 | $131 | — | — | — | $131 – $131 |
| 22 | Optum vaccn optum other · outpatient | $131 | $131 | — | — | — | $131 – $131 |
| 23 | UnitedHealthcare uhc medicare advantage other · outpatient | $132 | $132 | — | — | 3–30 | $132 – $132 |
| 24 | Aetna aetna medicare advantage other · outpatient | $133 | $133 | — | — | — | $133 – $133 |
| 25 | WellCare wellcare medicare advantage other · outpatient | $134 | $134 | — | — | — | $134 – $134 |
Last updated: Aug 7, 2026
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