CT scan of face and jaw without 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 MAXFACIAL WO CONTRST

Winston-Salem, NC

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How this price compares nationally

Forsyth Memorial Hospital, Inc.’s median price of $315 is 2% below the median hospital's median price ($321), higher than 50% of the 2,630 hospitals reporting CPT 70486. The highlighted bar is where this hospital falls; shaded is the middle 50% of hospitals.

Payers reporting CPT 70486 at Forsyth Memorial Hospital, Inc.

Negotiated rates from the hospital’s own file: 11 payers, 29 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	$101.39	$101.39	$101.39 – $101.39
2	Humana medicare fee schedule · outpatient	$101.39	$101.39	$101.39 – $101.39
3	UnitedHealthcare medicare fee schedule · outpatient	$101.39	$101.39	$101.39 – $101.39
4	Aetna medicare fee schedule · outpatient	$103.92	$103.92	$103.92 – $103.92
5	Cigna healthspring fee schedule · outpatient	$104.43	$104.43	$104.43 – $104.43
6	Blue Cross Blue Shield healthy blue medicaid fee schedule · outpatient	$305.31	$305.31	$295.27 – $315.35
7	UnitedHealthcare medicaid fee schedule · outpatient	$305.31	$305.31	$295.27 – $315.35
8	WellCare medicaid fee schedule · outpatient	$305.31	$305.31	$295.27 – $315.35
9	Cigna aca fee schedule · outpatient	$623.84	$623.84	$603.33 – $644.35
10	Caresource qualified health plan fee schedule · outpatient	$644.80	$644.80	$623.60 – $666.00
11	Blue Cross Blue Shield blue home fee schedule · outpatient	$841.46	$841.46	$813.79 – $869.13
12	Blue Cross Blue Shield blue value fee schedule · outpatient	$870.48	$870.48	$841.86 – $899.10
13	Cigna commercial fee schedule · outpatient	$957.53	$957.53	$926.04 – $989.01
14	Aetna commercial fee schedule · outpatient	$992.99	$992.99	$960.34 – $1,026
15	UnitedHealthcare all payer fee schedule · outpatient	$1,085	$1,085	$1,049 – $1,121
16	Blue Cross Blue Shield hmo fee schedule · outpatient	$1,107	$1,107	$1,071 – $1,144
17	Blue Cross Blue Shield ppo fee schedule · outpatient	$1,107	$1,107	$1,071 – $1,144
18	Cigna commercial percent of total billed charges · outpatientfrom % of charges	$1,149	$1,149	$1,149 – $1,149
19	Humana commercial fee schedule · outpatient	$1,256	$1,256	$1,214 – $1,297
20	Aetna aca fee schedule · outpatient	$1,290	$1,290	$1,247 – $1,332
21	Aetna first health fee schedule · outpatient	$1,290	$1,290	$1,247 – $1,332
22	Aetna non-par products of apcn fee schedule · outpatient	$1,290	$1,290	$1,247 – $1,332
23	Aetna rental network products fee schedule · outpatient	$1,290	$1,290	$1,247 – $1,332
24	Aetna whole health non-multitier fee schedule · outpatient	$1,290	$1,290	$1,247 – $1,332
25	Medcost mbs fee schedule · outpatient	$1,370	$1,370	$1,325 – $1,415

Page 1 of 2 · 29 rates

Last updated: Mar 30, 2026

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