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
HCHG 70487 CT MAXILLA W/IV CONT
West Union, IA
See all hospitals reporting CPT 70487 →Price type
Gundersen Palmer Lutheran Hospital and Clinic Inc’s median price of $866 is 103% above the median hospital's median price ($427), higher than 71% of the 2,577 hospitals reporting CPT 70487. The highlighted bar is where this hospital falls; shaded is the middle 50% of hospitals.
Negotiated rates from the hospital’s own file: 7 payers, 16 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 | Molina managed medicaid facility · other · outpatient | $144.33 | $144.33 | $144.33 – $144.33 |
| 2 | Wellmark hmo facility · case rate · outpatient | $737.89 | $737.89 | $737.89 – $737.89 |
| 3 | Wellmark indemnity/ppo facility · case rate · outpatient | $810.21 | $810.21 | $810.21 – $810.21 |
| 4 | UnitedHealthcare all payer appendix facility · percent of total billed charges · outpatientfrom % of charges | $825.84 | $825.84 | $825.84 – $825.84 |
| 5 | Wellmark all products facility · percent of total billed charges · outpatientfrom % of charges | $849.15 | $849.15 | $849.15 – $849.15 |
| 6 | Aetna medicare advantage facility · percent of total billed charges · outpatientfrom % of charges | $865.80 | $865.80 | $865.80 – $865.80 |
| 7 | Humana medicare advantage facility · percent of total billed charges · outpatientfrom % of charges | $865.80 | $865.80 | $865.80 – $865.80 |
| 8 | UnitedHealthcare medicare advantage facility · percent of total billed charges · outpatientfrom % of charges | $865.80 | $865.80 | $865.80 – $865.80 |
| 9 | Wellmark medicare advantage facility · percent of total billed charges · outpatientfrom % of charges | $865.80 | $865.80 | $865.80 – $865.80 |
| 10 | Ucare dually eligible facility · percent of total billed charges · outpatientfrom % of charges | $915.75 | $915.75 | $915.75 – $915.75 |
| 11 | Ucare msho/minnesota special needs facility · percent of total billed charges · outpatientfrom % of charges | $915.75 | $915.75 | $915.75 – $915.75 |
| 12 | Ucare non-dually eligible facility · percent of total billed charges · outpatientfrom % of charges | $915.75 | $915.75 | $915.75 – $915.75 |
| 13 | Ucare qualified health plan facility · percent of total billed charges · outpatientfrom % of charges | $1,332 | $1,332 | $1,332 – $1,332 |
| 14 | Aetna all products facility · percent of total billed charges · outpatientfrom % of charges | $1,365 | $1,365 | $1,365 – $1,365 |
| 15 | MultiPlan healtheos plus facility · percent of total billed charges · outpatientfrom % of charges | $1,465 | $1,465 | $1,465 – $1,465 |
| 16 | MultiPlan mpi_phcs_healtheos facility · percent of total billed charges · outpatientfrom % of charges | $1,548 | $1,548 | $1,548 – $1,548 |
Last updated: Jun 27, 2026
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