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
NJX AA&/STRD AX NERVE IMG
Waco, TX
See all hospitals reporting CPT 64417 →Price type
Ascension Providence’s median price of $873 is 20% below the median hospital's median price ($1.1k), higher than 28% of the 2,039 hospitals reporting CPT 64417. The highlighted bar is where this hospital falls; shaded is the middle 50% of hospitals.
Negotiated rates from the hospital’s own file: 8 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 | Blue Cross Blue Shield 975_bcbs star outpatient 20241201 fee schedule · outpatient | $341 | $341 | — | — | — | $341 – $341 |
| 2 | Molina 908_molina chip outpatient 20241201 fee schedule · outpatient | $341 | $341 | — | — | — | $341 – $341 |
| 3 | Superior Healthplan 904_superior star outpatient 20241201 fee schedule · outpatient | $341 | $341 | — | — | — | $341 – $341 |
| 4 | Superior Healthplan 907_superior star plus outpatient 20241201 fee schedule · outpatient | $341 | $341 | — | — | — | $341 – $341 |
| 5 | UnitedHealthcare 906_uhc star plus outpatient 20241201 fee schedule · outpatient | $341 | $341 | — | — | — | $341 – $341 |
| 6 | UnitedHealthcare 909_uhc star kids outpatient 20241201 fee schedule · outpatient | $341 | $341 | — | — | — | $341 – $341 |
| 7 | UnitedHealthcare 928_uhc star outpatient 20250701 fee schedule · outpatient | $341 | $341 | — | — | — | $341 – $341 |
| 8 | Blue Cross Blue Shield 872_blue cross blue shield myblueheath 20250101 fee schedule · outpatient | $650 | $650 | — | — | — | $650 – $650 |
| 9 | Blue Cross Blue Shield 871_blue cross blue shield advantage hmo 20250101 fee schedule · outpatient | $812 | $812 | — | — | — | $812 – $812 |
| 10 | Tricare 877_tricare outpatient 20250101 other · outpatient | $873 | $873 | — | — | — | $873 – $873 |
| 11 | Tricare 986_tricare inpatient 20251001 other · inpatient | $873 | $873 | — | — | — | $873 – $873 |
| 12 | WellCare 918_wellcare allwell medicare advantage outpatient 20250101 other · outpatient | $873 | $873 | — | — | — | $873 – $873 |
| 13 | WellCare 994_wellcare allwell medicare advantage inpatient 20251001 other · inpatient | $873 | $873 | — | — | — | $873 – $873 |
| 14 | Aetna 880_medicare advantage aetna outpatient 20250101 other · outpatient | $890 | $890 | — | — | — | $890 – $890 |
| 15 | Aetna 989_medicare advantage aetna inpatient 20251001 other · inpatient | $890 | $890 | — | — | — | $890 – $890 |
| 16 | UnitedHealthcare 883_medicare advantage united healthcare outpatient 20250101 other · outpatient | $890 | $890 | — | — | — | $890 – $890 |
| 17 | UnitedHealthcare 991_medicare advantage united healthcare inpatient 20251001 other · inpatient | $890 | $890 | — | — | — | $890 – $890 |
| 18 | Ambetter 876_superior ambetter outpatient 20250101 other · outpatient | $1.3k | $1.3k | — | — | — | $1.3k – $1.3k |
| 19 | Ambetter 985_superior ambetter inpatient 20251001 other · inpatient | $1.3k | $1.3k | — | — | — | $1.3k – $1.3k |
| 20 | Blue Cross Blue Shield 870_blue cross blue shield hmo essentials 20250101 fee schedule · outpatient | $1.4k | $1.4k | — | — | — | $1.4k – $1.4k |
| 21 | Blue Cross Blue Shield 869_blue cross blue shield ppo 20250101 fee schedule · outpatient | $1.5k | $1.5k | — | — | — | $1.5k – $1.5k |
Last updated: Jan 1, 2026
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