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
Ct maxillofacial w/dye
Lebanon, NH
See all hospitals reporting CPT 70487 →Price type
Mary Hitchcock Memorial Hospital’s median price of $268 is 37% below the median hospital's median price ($427), higher than 32% 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: 10 payers, 102 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 | Amerihealth Caritas amerihealth caritas - nh managed medicaid - dhp professional · fee schedule · outpatient | $68.79 | $68.79 | $41.66 – $95.92 |
| 2 | Anthem anthem - medicare advantage - dhp professional · fee schedule · outpatient | $73.34 | $73.34 | $51.72 – $94.96 |
| 3 | Bcbs Vt bcbs of vermont - medicare advantage - dhp professional · fee schedule · outpatient | $73.34 | $73.34 | $51.72 – $94.96 |
| 4 | UnitedHealthcare uhc - medicare advantage - dhp professional · fee schedule · outpatient | $73.34 | $73.34 | $51.72 – $94.96 |
| 5 | UnitedHealthcare uhc - va community care network - dhpn professional · fee schedule · outpatient | $73.34 | $73.34 | $51.72 – $94.96 |
| 6 | Aetna aetna medicare advantage - dhp professional · fee schedule · outpatient | $75.54 | $75.54 | $53.27 – $97.80 |
| 7 | WellCare wellcare - medicare advantage - dhp professional · fee schedule · outpatient | $76.27 | $76.27 | $53.78 – $98.75 |
| 8 | Ambetter ambetter commercial - exchange behavioral health - dhp professional · fee schedule · outpatient | $77.00 | $77.00 | $54.30 – $99.70 |
| 9 | Cigna cigna medicare advantage - dhp professional · fee schedule · outpatient | $97.80 | $85.23 | $53.27 – $104.63 |
| 10 | UnitedHealthcare uhc - tiered freedom plan professional · fee schedule · outpatient | $94.45 | $94.45 | $63.02 – $125.88 |
| 11 | UnitedHealthcare uhc - freedom plan - dhp professional · fee schedule · outpatient | $104.95 | $104.95 | $70.02 – $139.87 |
| 12 | Ambetter ambetter commercial - exchange - dhpn professional · fee schedule · outpatient | $132.49 | $132.49 | $94.96 – $170.02 |
| 13 | Amerihealth Caritas amerihealth caritas - nh managed medicaid professional · percent of total billed charges · outpatientfrom % of charges | $133.13 | $133.13 | $133.13 – $133.13 |
| 14 | UnitedHealthcare uhc - va community care network - dhps professional · fee schedule · outpatient | $153.31 | $153.31 | $153.31 – $153.31 |
| 15 | Amerihealth Caritas amerihealth caritas - nh managed medicaid professional · fee schedule · outpatient | $159.44 | $159.44 | $159.44 – $159.44 |
| 16 | Ambetter ambetter commercial - exchange - dhps professional · fee schedule · outpatient | $181.82 | $181.82 | $122.67 – $240.97 |
| 17 | Anthem anthem - medicare advantage facility · case rate · outpatient | $199.21 | $199.21 | $199.21 – $199.21 |
| 18 | Bcbs Vt bcbs of vermont - medicare advantage facility · case rate · outpatient | $199.21 | $199.21 | $199.21 – $199.21 |
| 19 | UnitedHealthcare uhc - medicare advantage facility · case rate · outpatient | $199.21 | $199.21 | $199.21 – $199.21 |
| 20 | UnitedHealthcare uhc - va community care network facility · case rate · outpatient | $199.21 | $199.21 | $199.21 – $199.21 |
| 21 | Cigna cigna hmo-pos professional · fee schedule · outpatient | $200.79 | $200.79 | $133.97 – $267.61 |
| 22 | Aetna aetna medicare advantage facility · case rate · outpatient | $205.19 | $205.19 | $205.19 – $205.19 |
| 23 | Cigna cigna medicare advantage facility · case rate · outpatient | $205.19 | $205.19 | $205.19 – $205.19 |
| 24 | WellCare wellcare - medicare advantage facility · case rate · outpatient | $207.18 | $207.18 | $207.18 – $207.18 |
| 25 | Cigna cigna hmo-pos - dhp professional · fee schedule · outpatient | $223.86 | $223.86 | $146.90 – $300.82 |
Last updated: Jan 1, 2026
See CT scan of face and jaw with contrast dye pricing across every hospital in the network reporting it, or ask Claude or any MCP client directly — see how to connect.