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
DSTRN NEUR AG GNB W IMAGE
Folsom, CA
See all hospitals reporting CPT 64624 →Price type
Dignity Health’s median price of $2.6k is 18% above the median hospital's median price ($2.2k), higher than 63% of the 1,997 hospitals reporting CPT 64624. The highlighted bar is where this hospital falls; shaded is the middle 50% of hospitals.
Negotiated rates from the hospital’s own file: 9 payers, 32 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 medicaid|< 21 fee schedule · outpatient | $375 | $375 | — | — | — | $375 – $375 |
| 2 | UnitedHealthcare medicaid|> 21 fee schedule · outpatient | $375 | $375 | — | — | — | $375 – $375 |
| 3 | Molina medicaid|all plans fee schedule · outpatient | $705 | $705 | — | — | — | $705 – $705 |
| 4 | Anthem medicaid|all plans fee schedule · outpatient | $713 | $713 | — | — | — | $713 – $713 |
| 5 | Blue Cross Blue Shield commercial|aco trio case rate · outpatient | $856 | $856 | — | — | — | $856 – $856 |
| 6 | Blue Cross Blue Shield commercial|exchange case rate · outpatient | $1.1k | $1.1k | — | — | — | $1.1k – $1.1k |
| 7 | Blue Cross Blue Shield commercial|aco trio calpers case rate · outpatient | $1.1k | $1.1k | — | — | — | $1.1k – $1.1k |
| 8 | Blue Cross Blue Shield commercial|ppo tandem case rate · outpatient | $1.6k | $1.6k | — | — | — | $1.6k – $1.6k |
| 9 | Blue Cross Blue Shield commercial|hmo case rate · outpatient | $1.6k | $1.6k | — | — | — | $1.6k – $1.6k |
| 10 | Blue Cross Blue Shield commercial|calpers case rate · outpatient | $1.7k | $1.7k | — | — | — | $1.7k – $1.7k |
| 11 | Blue Cross Blue Shield commercial|all other plans case rate · outpatient | $1.9k | $1.9k | — | — | — | $1.9k – $1.9k |
| 12 | Anthem medicare|all other plans fee schedule · outpatient | $2.4k | $2.4k | — | — | — | $2.4k – $2.4k |
| 13 | Aetna medicare|all plans fee schedule · outpatient | $2.6k | $2.6k | — | — | — | $2.6k – $2.6k |
| 14 | Blue Cross Blue Shield medicare|hmo case rate · outpatient | $2.6k | $2.6k | — | — | — | $2.6k – $2.6k |
| 15 | Blue Cross Blue Shield medicare|ppo fee schedule · outpatient | $2.6k | $2.6k | — | — | — | $2.6k – $2.6k |
| 16 | Humana commercial|all plans fee schedule · outpatient | $2.6k | $2.6k | — | — | — | $2.6k – $2.6k |
| 17 | Kaiser medicare|all plans case rate · outpatient | $2.6k | $2.6k | — | — | — | $2.6k – $2.6k |
| 18 | UnitedHealthcare medicare|all plans case rate · outpatient | $2.6k | $2.6k | — | — | — | $2.6k – $2.6k |
| 19 | Anthem medicare|imperial fee schedule · outpatient | $2.6k | $2.6k | — | — | — | $2.6k – $2.6k |
| 20 | Kaiser medicaid|all plans fee schedule · outpatient | $2.7k | $2.7k | — | — | — | $2.7k – $2.7k |
| 21 | Anthem commercial|connection epo case rate · outpatient | $4.0k | $4.0k | — | — | — | $4.0k – $4.0k |
| 22 | First Health commercial|all plans fee schedule · inpatient | $4.9k | $4.9k | — | — | — | $4.9k – $4.9k |
| 23 | First Health commercial|all plans fee schedule · outpatient | $4.9k | $4.9k | — | — | — | $4.9k – $4.9k |
| 24 | Anthem commercial|all other plans case rate · outpatient | $5.1k | $5.1k | — | — | — | $5.1k – $5.1k |
| 25 | Kaiser commercial|all plans fee schedule · outpatient | $5.2k | $5.2k | — | — | — | $5.2k – $5.2k |
Last updated: Feb 28, 2026
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