CT scan of face and jaw with contrast dye at Forsyth Memorial Hospital, Inc.

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.

Model: claude-haiku-5-5
Provider: anthropic
API: message_batches
Reasoning effort: low
Max output tokens: 4096
Prompt version (hash): 444523875572
Generated: October 20, 2026

Original text from hospital filings

CT SINUS MAXILLOFACIAL W CONT

Clemmons, NC

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How this price compares nationally

Forsyth Memorial Hospital, Inc.’s median price of $347 is 19% below the median hospital's median price ($427), higher than 42% of the 2,577 hospitals reporting CPT 70487. The highlighted bar is where this hospital falls; shaded is the middle 50% of hospitals.

Payers reporting CPT 70487 at Forsyth Memorial Hospital, Inc.

Negotiated rates from the hospital’s own file: 11 payers, 28 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 blue medicare fee schedule · outpatient	$170.11	$170.11	$170.11 – $170.11
2	Humana medicare fee schedule · outpatient	$170.11	$170.11	$170.11 – $170.11
3	UnitedHealthcare medicare fee schedule · outpatient	$170.11	$170.11	$170.11 – $170.11
4	Aetna medicare fee schedule · outpatient	$174.36	$174.36	$174.36 – $174.36
5	Cigna healthspring fee schedule · outpatient	$175.21	$175.21	$175.21 – $175.21
6	Blue Cross Blue Shield healthy blue medicaid fee schedule · outpatient	$346.60	$346.60	$346.60 – $346.60
7	UnitedHealthcare medicaid fee schedule · outpatient	$346.60	$346.60	$346.60 – $346.60
8	WellCare medicaid fee schedule · outpatient	$346.60	$346.60	$346.60 – $346.60
9	Cigna aca fee schedule · outpatient	$708.21	$708.21	$708.21 – $708.21
10	Caresource qualified health plan fee schedule · outpatient	$732.00	$732.00	$732.00 – $732.00
11	Blue Cross Blue Shield blue home fee schedule · outpatient	$955.26	$955.26	$955.26 – $955.26
12	Blue Cross Blue Shield blue value fee schedule · outpatient	$988.20	$988.20	$988.20 – $988.20
13	Cigna commercial fee schedule · outpatient	$1,087	$1,087	$1,087 – $1,087
14	Aetna commercial fee schedule · outpatient	$1,127	$1,127	$1,127 – $1,127
15	UnitedHealthcare all payer fee schedule · outpatient	$1,232	$1,232	$1,232 – $1,232
16	Blue Cross Blue Shield hmo fee schedule · outpatient	$1,257	$1,257	$1,257 – $1,257
17	Blue Cross Blue Shield ppo fee schedule · outpatient	$1,257	$1,257	$1,257 – $1,257
18	Humana commercial fee schedule · outpatient	$1,426	$1,426	$1,426 – $1,426
19	Aetna aca fee schedule · outpatient	$1,464	$1,464	$1,464 – $1,464
20	Aetna first health fee schedule · outpatient	$1,464	$1,464	$1,464 – $1,464
21	Aetna non-par products of apcn fee schedule · outpatient	$1,464	$1,464	$1,464 – $1,464
22	Aetna rental network products fee schedule · outpatient	$1,464	$1,464	$1,464 – $1,464
23	Aetna whole health non-multitier fee schedule · outpatient	$1,464	$1,464	$1,464 – $1,464
24	Medcost mbs fee schedule · outpatient	$1,556	$1,556	$1,556 – $1,556
25	Beechstreet commercial fee schedule · outpatient	$1,647	$1,647	$1,647 – $1,647

Page 1 of 2 · 28 rates

Last updated: Mar 30, 2026

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