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
DST NULYT AGT GNCLR NRV W/IMG
Pittsburgh, PA
See all hospitals reporting CPT 64624 →Price type
UPMC Mercy’s median price of $1.1k is 51% below the median hospital's median price ($2.2k), higher than 16% of the 1,997 hospitals reporting CPT 64624. The highlighted bar is where this hospital falls; shaded is the middle 50% of hospitals.
Negotiated rates from the hospital’s own file: 6 payers, 26 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 | Highmark complete blue medicare advantage/freedom blue medicare advantage/security blue medicare advantage facility · fee schedule · outpatient | $222 | $222 | — | — | — | $222 – $222 |
| 2 | Highmark managed care - social mission facility · fee schedule · outpatient | $501 | $501 | — | — | — | $501 – $501 |
| 3 | Aetna neighborhood network facility · percent of total billed charges · outpatientfrom % of charges | $583 | $583 | — | — | — | $583 – $583 |
| 4 | Aetna home depot employer group facility · percent of total billed charges · outpatientfrom % of charges | $636 | $636 | — | — | — | $636 – $636 |
| 5 | Aetna neighborhood network facility · percent of total billed charges · inpatientfrom % of charges | $639 | $639 | — | — | — | $639 – $639 |
| 6 | Aetna nbr aso/fi facility · percent of total billed charges · outpatientfrom % of charges | $648 | $648 | — | — | — | $648 – $648 |
| 7 | Highmark managed care facility · fee schedule · outpatient | $671 | $671 | — | — | — | $671 – $671 |
| 8 | Aetna home depot employer group facility · percent of total billed charges · inpatientfrom % of charges | $696 | $696 | — | — | — | $696 – $696 |
| 9 | Aetna nbr aso/fi facility · percent of total billed charges · inpatientfrom % of charges | $710 | $710 | — | — | — | $710 – $710 |
| 10 | Cigna new business aso facility · percent of total billed charges · inpatientfrom % of charges | $710 | $710 | — | — | — | $710 – $710 |
| 11 | Aetna ebr fi facility · percent of total billed charges · inpatientfrom % of charges | $794 | $794 | — | — | — | $794 – $794 |
| 12 | Aetna ebr fi facility · percent of total billed charges · outpatientfrom % of charges | $794 | $794 | — | — | — | $794 – $794 |
| 13 | Aetna ebr aso facility · percent of total billed charges · inpatientfrom % of charges | $836 | $836 | — | — | — | $836 – $836 |
| 14 | Aetna ebr aso facility · percent of total billed charges · outpatientfrom % of charges | $836 | $836 | — | — | — | $836 – $836 |
| 15 | Cigna new business aso facility · percent of total billed charges · outpatientfrom % of charges | $856 | $856 | — | — | — | $856 – $856 |
| 16 | First Health commercial facility · percent of total billed charges · inpatientfrom % of charges | $919 | $919 | — | — | — | $919 – $919 |
| 17 | First Health commercial facility · percent of total billed charges · outpatientfrom % of charges | $919 | $919 | — | — | — | $919 – $919 |
| 18 | Highmark commercial - social mission indemnity facility · fee schedule · outpatient | $1.0k | $1.0k | — | — | — | $1.0k – $1.0k |
| 19 | Cigna commercial facility · percent of total billed charges · inpatientfrom % of charges | $1.0k | $1.0k | $209 | 20% | — | $836 – $1.3k |
| 20 | Cigna commercial facility · percent of total billed charges · outpatientfrom % of charges | $1.0k | $1.0k | $209 | 20% | — | $836 – $1.3k |
| 21 | Highmark commercial - indemnity facility · fee schedule · outpatient | $1.4k | $1.4k | — | — | — | $1.4k – $1.4k |
| 22 | MultiPlan ppo (inc. auto and worker's compensation) facility · percent of total billed charges · inpatientfrom % of charges | $1.9k | $1.9k | — | — | — | $1.9k – $1.9k |
| 23 | MultiPlan ppo (inc. auto and worker's compensation) facility · percent of total billed charges · outpatientfrom % of charges | $1.9k | $1.9k | — | — | — | $1.9k – $1.9k |
| 24 | Aetna medicare facility · fee schedule · outpatient | $2.0k | $2.0k | $47 | 2% | — | $2.0k – $2.0k |
| 25 | Amerihealth Caritas medicare facility · fee schedule · outpatient | $2.0k | $2.0k | — | — | — | $2.0k – $2.0k |
Last updated: Mar 6, 2026
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