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 Class De 5 or More
Utica, NY
See all hospitals reporting HCPCS G0109 →Price type
MVHS, Inc.’s median price of $16 is 40% below the median hospital's median price ($26), higher than 12% of the 1,867 hospitals reporting HCPCS G0109. The highlighted bar is where this hospital falls; shaded is the middle 50% of hospitals.
Negotiated rates from the hospital’s own file: 11 payers, 20 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 fee schedule · outpatient | $14 | $14 | — | — | — | $14 – $14 |
| 2 | Humana humana military fee schedule · outpatient | $14 | $14 | — | — | — | $14 – $14 |
| 3 | Tricare humana military fee schedule · outpatient | $14 | $14 | — | — | — | $14 – $14 |
| 4 | Excellus excellus bcbs medicare advantage fee schedule · outpatient | $16 | $16 | — | — | — | $16 – $16 |
| 5 | Humana humana medicare advantage fee schedule · outpatient | $16 | $16 | — | — | — | $16 – $16 |
| 6 | Medicare medicare fee schedule · outpatient | $16 | $16 | — | — | — | $16 – $16 |
| 7 | Optum vaccn optum fee schedule · outpatient | $16 | $16 | — | — | — | $16 – $16 |
| 8 | UnitedHealthcare uhc medicare advantage fee schedule · outpatient | $16 | $16 | — | — | — | $16 – $16 |
| 9 | Aetna aetna medicare advantage fee schedule · outpatient | $16 | $16 | — | — | — | $16 – $16 |
| 10 | WellCare wellcare medicare advantage fee schedule · outpatient | $16 | $16 | — | — | — | $16 – $16 |
| 11 | Aetna aetna commercial percent of total billed charges · bothfrom % of charges | $57 | $57 | $17 | 31% | — | $39 – $74 |
| 12 | Humana humana hmo/pos percent of total billed charges · inpatientfrom % of charges | $62 | $62 | $19 | 31% | — | $43 – $81 |
| 13 | Bcbs Ny excellus bcbs indemnity percent of total billed charges · bothfrom % of charges | $65 | $65 | $20 | 31% | — | $45 – $84 |
| 14 | Blue Cross Blue Shield excellus bcbs hmo/ppo percent of total billed charges · bothfrom % of charges | $65 | $65 | $20 | 31% | — | $45 – $84 |
| 15 | Excellus excellus bcbs hmo/ppo percent of total billed charges · bothfrom % of charges | $65 | $65 | $20 | 31% | 4–40 | $45 – $84 |
| 16 | Excellus excellus bcbs indemnity percent of total billed charges · bothfrom % of charges | $65 | $65 | $20 | 31% | — | $45 – $84 |
| 17 | Cigna mvp and cigna commercial percent of total billed charges · bothfrom % of charges | $67 | $67 | $21 | 31% | — | $47 – $88 |
| 18 | UnitedHealthcare uhc commercial percent of total billed charges · bothfrom % of charges | $69 | $69 | $21 | 31% | — | $48 – $91 |
| 19 | UnitedHealthcare uhc empire plan percent of total billed charges · bothfrom % of charges | $69 | $69 | $21 | 31% | — | $48 – $91 |
| 20 | Humana humana hmo/pos percent of total billed charges · outpatientfrom % of charges | $71 | $71 | $22 | 31% | — | $50 – $93 |
Last updated: Aug 7, 2026
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