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

Winston-Salem, NC

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Pricing by billing methodology

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How this price compares nationally

Forsyth Memorial Hospital, Inc.’s median price of $339 is 21% 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, 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	$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	$339.02	$339.02	$339.02 – $339.02
7	UnitedHealthcare medicaid fee schedule · outpatient	$339.02	$339.02	$339.02 – $339.02
8	WellCare medicaid fee schedule · outpatient	$339.02	$339.02	$339.02 – $339.02
9	Cigna aca fee schedule · outpatient	$692.73	$692.73	$692.73 – $692.73
10	Caresource qualified health plan fee schedule · outpatient	$716.00	$716.00	$716.00 – $716.00
11	Blue Cross Blue Shield blue home fee schedule · outpatient	$934.38	$934.38	$934.38 – $934.38
12	Blue Cross Blue Shield blue value fee schedule · outpatient	$966.60	$966.60	$966.60 – $966.60
13	Cigna commercial fee schedule · outpatient	$1,063	$1,063	$1,063 – $1,063
14	Cigna commercial percent of total billed charges · outpatientfrom % of charges	$1,063	$1,063	$1,063 – $1,063
15	Aetna commercial fee schedule · outpatient	$1,103	$1,103	$1,103 – $1,103
16	UnitedHealthcare all payer fee schedule · outpatient	$1,205	$1,205	$1,205 – $1,205
17	Blue Cross Blue Shield hmo fee schedule · outpatient	$1,230	$1,230	$1,230 – $1,230
18	Blue Cross Blue Shield ppo fee schedule · outpatient	$1,230	$1,230	$1,230 – $1,230
19	Humana commercial fee schedule · outpatient	$1,394	$1,394	$1,394 – $1,394
20	Aetna aca fee schedule · outpatient	$1,432	$1,432	$1,432 – $1,432
21	Aetna first health fee schedule · outpatient	$1,432	$1,432	$1,432 – $1,432
22	Aetna non-par products of apcn fee schedule · outpatient	$1,432	$1,432	$1,432 – $1,432
23	Aetna rental network products fee schedule · outpatient	$1,432	$1,432	$1,432 – $1,432
24	Aetna whole health non-multitier fee schedule · outpatient	$1,432	$1,432	$1,432 – $1,432
25	Medcost mbs fee schedule · outpatient	$1,522	$1,522	$1,522 – $1,522

Page 1 of 2 · 29 rates

Last updated: Mar 30, 2026

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