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Charge Type Price  
Service Code CPT 97151
Hospital Charge Code 1
Min. Negotiated Rate $23.55
Max. Negotiated Rate $41.67
Rate for Payer: Aetna Medicaid $23.55
Rate for Payer: BCBS Blue Traditional $41.67
Rate for Payer: Cash Price $23.55
Rate for Payer: Humana Medicaid $23.55
Rate for Payer: Oklahoma Complete Medicaid $23.55
Rate for Payer: Sooner Care Medicaid $23.55
Rate for Payer: TRICARE TRICARE $40.00
Service Code CPT 97155
Hospital Charge Code 2
Min. Negotiated Rate $23.55
Max. Negotiated Rate $32.00
Rate for Payer: Aetna Medicaid $23.55
Rate for Payer: BCBS Blue Traditional $24.21
Rate for Payer: Cash Price $23.55
Rate for Payer: Humana Medicaid $23.55
Rate for Payer: Oklahoma Complete Medicaid $23.55
Rate for Payer: Sooner Care Medicaid $23.55
Rate for Payer: TRICARE TRICARE $32.00
Service Code CPT 97156
Hospital Charge Code 3
Min. Negotiated Rate $23.08
Max. Negotiated Rate $29.00
Rate for Payer: Aetna Medicaid $23.55
Rate for Payer: BCBS Blue Traditional $23.08
Rate for Payer: Cash Price $23.55
Rate for Payer: Humana Medicaid $23.55
Rate for Payer: Oklahoma Complete Medicaid $23.55
Rate for Payer: Sooner Care Medicaid $23.55
Rate for Payer: TRICARE TRICARE $29.00
Service Code CPT 97153
Hospital Charge Code 4
Min. Negotiated Rate $12.11
Max. Negotiated Rate $21.00
Rate for Payer: Aetna Medicaid $17.35
Rate for Payer: BCBS Blue Traditional $12.11
Rate for Payer: Cash Price $17.35
Rate for Payer: Humana Medicaid $17.35
Rate for Payer: Oklahoma Complete Medicaid $17.35
Rate for Payer: Sooner Care Medicaid $17.35
Rate for Payer: TRICARE TRICARE $21.00
Service Code CPT 95977
Hospital Charge Code 5
Min. Negotiated Rate $35.21
Max. Negotiated Rate $174.67
Rate for Payer: Aetna Medicaid $46.37
Rate for Payer: BCBS Blue Traditional $44.33
Rate for Payer: Cash Price $46.37
Rate for Payer: HealthChoice Medicaid $174.67
Rate for Payer: Humana Medicaid $46.37
Rate for Payer: Oklahoma Complete Medicaid $46.37
Rate for Payer: Sooner Care Medicaid $46.37
Rate for Payer: TRICARE TRICARE $50.29
Rate for Payer: United Health Medicaid $35.21
Service Code CPT 95970
Hospital Charge Code 6
Min. Negotiated Rate $12.64
Max. Negotiated Rate $18.05
Rate for Payer: Aetna Medicaid $16.67
Rate for Payer: BCBS Blue Traditional $15.79
Rate for Payer: Cash Price $16.67
Rate for Payer: Humana Medicaid $16.67
Rate for Payer: Oklahoma Complete Medicaid $16.67
Rate for Payer: Sooner Care Medicaid $16.67
Rate for Payer: TRICARE TRICARE $18.05
Rate for Payer: United Health Medicaid $12.64
Service Code CPT 99211
Hospital Charge Code 7
Min. Negotiated Rate $7.59
Max. Negotiated Rate $32.33
Rate for Payer: Aetna Medicaid $20.03
Rate for Payer: BCBS Blue Traditional $7.59
Rate for Payer: Cash Price $20.03
Rate for Payer: HealthChoice Medicaid $32.33
Rate for Payer: Humana Medicaid $20.03
Rate for Payer: Oklahoma Complete Medicaid $20.03
Rate for Payer: Sooner Care Medicaid $20.03
Rate for Payer: TRICARE TRICARE $21.38
Rate for Payer: United Health Medicaid $14.97
Service Code CPT 99212
Hospital Charge Code 8
Min. Negotiated Rate $37.08
Max. Negotiated Rate $80.09
Rate for Payer: Aetna Medicaid $49.44
Rate for Payer: BCBS Blue Traditional $56.57
Rate for Payer: Cash Price $49.44
Rate for Payer: HealthChoice Medicaid $80.09
Rate for Payer: Humana Medicaid $49.44
Rate for Payer: Oklahoma Complete Medicaid $49.44
Rate for Payer: Sooner Care Medicaid $49.44
Rate for Payer: TRICARE TRICARE $52.97
Rate for Payer: United Health Medicaid $37.08
Service Code CPT 99213
Hospital Charge Code 9
Min. Negotiated Rate $30.06
Max. Negotiated Rate $128.82
Rate for Payer: Aetna Medicaid $79.99
Rate for Payer: BCBS Blue Traditional $30.06
Rate for Payer: Cash Price $79.99
Rate for Payer: HealthChoice Medicaid $128.82
Rate for Payer: Humana Medicaid $79.99
Rate for Payer: Oklahoma Complete Medicaid $79.99
Rate for Payer: Sooner Care Medicaid $79.99
Rate for Payer: TRICARE TRICARE $85.19
Rate for Payer: United Health Medicaid $59.63
Service Code CPT 99214
Hospital Charge Code 10
Min. Negotiated Rate $83.49
Max. Negotiated Rate $182.65
Rate for Payer: Aetna Medicaid $113.10
Rate for Payer: BCBS Blue Traditional $83.49
Rate for Payer: Cash Price $113.10
Rate for Payer: HealthChoice Medicaid $182.65
Rate for Payer: Humana Medicaid $113.10
Rate for Payer: Oklahoma Complete Medicaid $113.10
Rate for Payer: Sooner Care Medicaid $113.10
Rate for Payer: TRICARE TRICARE $120.79
Rate for Payer: United Health Medicaid $84.55
Service Code CPT 99215
Hospital Charge Code 11
Min. Negotiated Rate $118.76
Max. Negotiated Rate $256.54
Rate for Payer: Aetna Medicaid $159.49
Rate for Payer: BCBS Blue Traditional $122.96
Rate for Payer: Cash Price $159.49
Rate for Payer: HealthChoice Medicaid $256.54
Rate for Payer: Humana Medicaid $159.49
Rate for Payer: Oklahoma Complete Medicaid $159.49
Rate for Payer: Sooner Care Medicaid $159.49
Rate for Payer: TRICARE TRICARE $169.65
Rate for Payer: United Health Medicaid $118.76
Service Code CPT 92610
Hospital Charge Code 12
Hospital Revenue Code 440
Min. Negotiated Rate $56.60
Max. Negotiated Rate $122.28
Rate for Payer: BCBS Blue Traditional $58.90
Rate for Payer: HealthChoice Medicaid $122.28
Rate for Payer: Humana Medicaid $75.41
Rate for Payer: Oklahoma Complete Medicaid $75.41
Rate for Payer: Sooner Care Medicaid $75.41
Rate for Payer: TRICARE TRICARE $80.86
Rate for Payer: United Health Medicaid $56.60
Service Code CPT 92610
Hospital Charge Code 13
Hospital Revenue Code 440
Min. Negotiated Rate $56.60
Max. Negotiated Rate $122.28
Rate for Payer: Aetna Medicaid $75.41
Rate for Payer: BCBS Blue Traditional $58.90
Rate for Payer: Cash Price $75.41
Rate for Payer: HealthChoice Medicaid $122.28
Rate for Payer: Humana Medicaid $75.41
Rate for Payer: Oklahoma Complete Medicaid $75.41
Rate for Payer: Sooner Care Medicaid $75.41
Rate for Payer: TRICARE TRICARE $80.86
Rate for Payer: United Health Medicaid $56.60
Service Code CPT 92526
Hospital Charge Code 15
Hospital Revenue Code 440
Min. Negotiated Rate $56.71
Max. Negotiated Rate $122.51
Rate for Payer: Aetna Medicaid $75.02
Rate for Payer: BCBS Blue Traditional $71.04
Rate for Payer: Cash Price $75.02
Rate for Payer: HealthChoice Medicaid $122.51
Rate for Payer: Humana Medicaid $75.02
Rate for Payer: Oklahoma Complete Medicaid $75.02
Rate for Payer: Sooner Care Medicaid $75.02
Rate for Payer: TRICARE TRICARE $81.02
Rate for Payer: United Health Medicaid $56.71
Service Code CPT 92526
Hospital Charge Code 14
Hospital Revenue Code 440
Min. Negotiated Rate $56.71
Max. Negotiated Rate $122.51
Rate for Payer: Aetna Medicaid $75.02
Rate for Payer: BCBS Blue Traditional $71.04
Rate for Payer: HealthChoice Medicaid $122.51
Rate for Payer: Humana Medicaid $75.02
Rate for Payer: Oklahoma Complete Medicaid $75.02
Rate for Payer: Sooner Care Medicaid $75.02
Rate for Payer: TRICARE TRICARE $81.02
Rate for Payer: United Health Medicaid $56.71
Service Code CPT 99205
Hospital Charge Code 16
Min. Negotiated Rate $145.85
Max. Negotiated Rate $315.07
Rate for Payer: Aetna Medicaid $161.05
Rate for Payer: BCBS Blue Traditional $154.84
Rate for Payer: Cash Price $161.05
Rate for Payer: HealthChoice Medicaid $315.07
Rate for Payer: Humana Medicaid $161.05
Rate for Payer: Oklahoma Complete Medicaid $161.05
Rate for Payer: Sooner Care Medicaid $161.05
Rate for Payer: TRICARE TRICARE $208.35
Rate for Payer: United Health Medicaid $145.85
Service Code CPT 99223
Hospital Charge Code 17
Min. Negotiated Rate $116.74
Max. Negotiated Rate $252.19
Rate for Payer: Aetna Medicaid $154.00
Rate for Payer: BCBS Blue Traditional $166.68
Rate for Payer: Cash Price $154.00
Rate for Payer: HealthChoice Medicaid $252.19
Rate for Payer: Humana Medicaid $154.00
Rate for Payer: Oklahoma Complete Medicaid $154.00
Rate for Payer: Sooner Care Medicaid $154.00
Rate for Payer: TRICARE TRICARE $166.77
Rate for Payer: United Health Medicaid $116.74
Service Code CPT 99221
Hospital Charge Code 18
Min. Negotiated Rate $55.73
Max. Negotiated Rate $120.40
Rate for Payer: Aetna Medicaid $73.41
Rate for Payer: BCBS Blue Traditional $83.79
Rate for Payer: Cash Price $73.41
Rate for Payer: HealthChoice Medicaid $120.40
Rate for Payer: Humana Medicaid $73.41
Rate for Payer: Oklahoma Complete Medicaid $73.41
Rate for Payer: Sooner Care Medicaid $73.41
Rate for Payer: TRICARE TRICARE $79.62
Rate for Payer: United Health Medicaid $55.73
Service Code CPT 99222
Hospital Charge Code 19
Min. Negotiated Rate $87.49
Max. Negotiated Rate $188.99
Rate for Payer: Aetna Medicaid $116.02
Rate for Payer: BCBS Blue Traditional $113.24
Rate for Payer: Cash Price $116.02
Rate for Payer: HealthChoice Medicaid $188.99
Rate for Payer: Humana Medicaid $116.02
Rate for Payer: Oklahoma Complete Medicaid $116.02
Rate for Payer: Sooner Care Medicaid $116.02
Rate for Payer: TRICARE TRICARE $124.98
Rate for Payer: United Health Medicaid $87.49
Service Code CPT 99202
Hospital Charge Code 20
Min. Negotiated Rate $41.29
Max. Negotiated Rate $102.69
Rate for Payer: Aetna Medicaid $63.23
Rate for Payer: BCBS Blue Traditional $41.29
Rate for Payer: Cash Price $63.23
Rate for Payer: HealthChoice Medicaid $102.69
Rate for Payer: Humana Medicaid $63.23
Rate for Payer: Oklahoma Complete Medicaid $63.23
Rate for Payer: Sooner Care Medicaid $63.23
Rate for Payer: TRICARE TRICARE $67.91
Rate for Payer: United Health Medicaid $47.54
Service Code CPT 99204
Hospital Charge Code 21
Min. Negotiated Rate $110.38
Max. Negotiated Rate $238.44
Rate for Payer: Aetna Medicaid $118.50
Rate for Payer: BCBS Blue Traditional $114.15
Rate for Payer: Cash Price $118.50
Rate for Payer: HealthChoice Medicaid $238.44
Rate for Payer: Humana Medicaid $118.50
Rate for Payer: Oklahoma Complete Medicaid $118.50
Rate for Payer: Sooner Care Medicaid $118.50
Rate for Payer: TRICARE TRICARE $157.68
Rate for Payer: United Health Medicaid $110.38
Service Code CPT 99203
Hospital Charge Code 22
Min. Negotiated Rate $70.13
Max. Negotiated Rate $159.77
Rate for Payer: Aetna Medicaid $72.81
Rate for Payer: BCBS Blue Traditional $70.13
Rate for Payer: Cash Price $72.81
Rate for Payer: HealthChoice Medicaid $159.77
Rate for Payer: Humana Medicaid $72.81
Rate for Payer: Oklahoma Complete Medicaid $72.81
Rate for Payer: Sooner Care Medicaid $72.81
Rate for Payer: TRICARE TRICARE $79.23
Rate for Payer: United Health Medicaid $73.96
Service Code CPT 99231
Hospital Charge Code 23
Min. Negotiated Rate $31.88
Max. Negotiated Rate $72.14
Rate for Payer: Aetna Medicaid $44.00
Rate for Payer: BCBS Blue Traditional $31.88
Rate for Payer: Cash Price $44.00
Rate for Payer: HealthChoice Medicaid $72.14
Rate for Payer: Humana Medicaid $44.00
Rate for Payer: Oklahoma Complete Medicaid $44.00
Rate for Payer: Sooner Care Medicaid $44.00
Rate for Payer: TRICARE TRICARE $47.70
Rate for Payer: United Health Medicaid $33.39
Service Code CPT 99232
Hospital Charge Code 24
Min. Negotiated Rate $53.23
Max. Negotiated Rate $114.99
Rate for Payer: Aetna Medicaid $70.09
Rate for Payer: BCBS Blue Traditional $59.81
Rate for Payer: Cash Price $70.09
Rate for Payer: HealthChoice Medicaid $114.99
Rate for Payer: Humana Medicaid $70.09
Rate for Payer: Oklahoma Complete Medicaid $70.09
Rate for Payer: Sooner Care Medicaid $70.09
Rate for Payer: TRICARE TRICARE $76.04
Rate for Payer: United Health Medicaid $53.23
Service Code CPT 99233
Hospital Charge Code 25
Min. Negotiated Rate $80.10
Max. Negotiated Rate $173.03
Rate for Payer: Aetna Medicaid $105.47
Rate for Payer: BCBS Blue Traditional $85.92
Rate for Payer: Cash Price $105.47
Rate for Payer: HealthChoice Medicaid $173.03
Rate for Payer: Humana Medicaid $105.47
Rate for Payer: Oklahoma Complete Medicaid $105.47
Rate for Payer: Sooner Care Medicaid $105.47
Rate for Payer: TRICARE TRICARE $114.42
Rate for Payer: United Health Medicaid $80.10