CT scan of face and jaw with contrast dye at Southeast Hospital dba Mercy Hospital Southeast

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 Maxillofacial Area W Cont

Girardeau, MO

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Pricing by billing methodology

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How this price compares nationally

Southeast Hospital dba Mercy Hospital Southeast’s median price of $290 is 32% below the median hospital's median price ($427), higher than 36% 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 Southeast Hospital dba Mercy Hospital Southeast

Negotiated rates from the hospital’s own file: 17 payers, 34 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	Medicaid hb cape mo medicaid facility · fee schedule · outpatient	$151.76	$151.76	$151.76 – $151.76
2	Aetna hb cape aetna medicare 100% facility · other · outpatient	$172.35	$172.35	$172.35 – $172.35
3	Blue Cross Blue Shield hb cape medicare and 100% managed medicare facility · other · outpatient	$172.35	$172.35	$172.35 – $172.35
4	Humana hb cape humana medicare ip 97% op 100% w/seq facility · other · outpatient	$172.35	$172.35	$172.35 – $172.35
5	Medica hb cape medicare and 100% managed medicare facility · other · outpatient	$172.35	$172.35	$172.35 – $172.35
6	Medicare hb cape medicare and 100% managed medicare facility · other · outpatient	$172.35	$172.35	$172.35 – $172.35
7	Tricare hb cape tricare facility · other · outpatient	$172.35	$172.35	$172.35 – $172.35
8	UnitedHealthcare hb cape uhc medicare advantage 100% facility · other · outpatient	$172.35	$172.35	$172.35 – $172.35
9	WellCare hb cape home state medicare advantage 100% w/seq facility · other · outpatient	$172.35	$172.35	$172.35 – $172.35
10	WellCare hb cape medicare and 100% managed medicare facility · other · outpatient	$172.35	$172.35	$172.35 – $172.35
11	Aetna hb stlo cape aetna better health of il medicaid new 040125 facility · percent of total billed charges · outpatientfrom % of charges	$176.35	$176.35	$176.35 – $176.35
12	Molina hb stlo cape molina healthchoice of il medicaid new 040125 facility · percent of total billed charges · outpatientfrom % of charges	$176.35	$176.35	$176.35 – $176.35
13	Devoted hb cape devoted health medicare advantage 104% w/seq facility · other · outpatient	$179.23	$179.23	$179.23 – $179.23
14	WellCare hb cape wellcare ky 105% medicare w/seq facility · other · outpatient	$181.13	$181.13	$181.13 – $181.13
15	Ambetter hb cape home state ambetter exchange bh & 130% mcr facility · other · outpatient	$222.99	$222.99	$222.99 – $222.99
16	UnitedHealthcare hb cape uhc managed medicaid facility · fee schedule · outpatient	$227.64	$227.64	$227.64 – $227.64
17	UnitedHealthcare hb cape dec rates ip 150% op 150% default 70% facility · other · outpatient	$258.52	$258.52	$258.52 – $258.52
18	Blue Cross Blue Shield hb cape missouri care health plan/healthy blue facility · fee schedule · outpatient	$273.17	$273.17	$273.17 – $273.17
19	Medicaid hb stlo cape il medicaid facility · percent of total billed charges · outpatientfrom % of charges	$406.95	$406.95	$406.95 – $406.95
20	UnitedHealthcare hb cape uhc exchange facility · other · outpatient	$421.64	$421.64	$421.64 – $421.64
21	Cigna hb cape cigna commercial facility · fee schedule · outpatient	$660.51	$660.51	$660.51 – $660.51
22	Anthem hb cape anthem blue preferred/alliance facility · fee schedule · outpatient	$688.10	$688.10	$688.10 – $688.10
23	Blue Cross Blue Shield hb cape anthem blue preferred/alliance facility · fee schedule · outpatient	$688.10	$688.10	$688.10 – $688.10
24	UnitedHealthcare hb cape stod uhc core facility · fee schedule · outpatient	$925.26	$925.26	$925.26 – $925.26
25	Anthem hb cape anthem blue access facility · fee schedule · outpatient	$969.27	$969.27	$969.27 – $969.27

Page 1 of 2 · 34 rates

Last updated: Jun 11, 2026

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