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Charge Type Price  
Hospital Charge Code 26
Hospital Revenue Code 138
Min. Negotiated Rate $2,325.00
Max. Negotiated Rate $2,325.00
Rate for Payer: Aetna Medicaid $2,325.00
Rate for Payer: BCBS Blue Traditional $2,325.00
Rate for Payer: Cash Price $2,325.00
Rate for Payer: HealthChoice Medicaid $2,325.00
Rate for Payer: Humana Medicaid $2,325.00
Rate for Payer: Oklahoma Complete Medicaid $2,325.00
Rate for Payer: Sooner Care Medicaid $2,325.00
Rate for Payer: TRICARE TRICARE $2,325.00
Rate for Payer: United Health Medicaid $2,325.00
Service Code CPT 97533
Hospital Charge Code 27
Hospital Revenue Code 430
Min. Negotiated Rate $41.21
Max. Negotiated Rate $89.02
Rate for Payer: Aetna Medicaid $53.54
Rate for Payer: BCBS Blue Traditional $48.24
Rate for Payer: HealthChoice Medicaid $89.02
Rate for Payer: Humana Medicaid $53.54
Rate for Payer: Oklahoma Complete Medicaid $53.54
Rate for Payer: Sooner Care Medicaid $53.54
Rate for Payer: TRICARE TRICARE $58.87
Rate for Payer: United Health Medicaid $41.21
Service Code CPT 97533
Hospital Charge Code 28
Hospital Revenue Code 430
Min. Negotiated Rate $41.21
Max. Negotiated Rate $89.02
Rate for Payer: Aetna Medicaid $53.54
Rate for Payer: BCBS Blue Traditional $48.24
Rate for Payer: Cash Price $53.54
Rate for Payer: HealthChoice Medicaid $89.02
Rate for Payer: Humana Medicaid $53.54
Rate for Payer: Oklahoma Complete Medicaid $53.54
Rate for Payer: Sooner Care Medicaid $53.54
Rate for Payer: TRICARE TRICARE $58.87
Rate for Payer: United Health Medicaid $41.21
Service Code CPT 97167
Hospital Charge Code 29
Hospital Revenue Code 430
Min. Negotiated Rate $67.13
Max. Negotiated Rate $145.02
Rate for Payer: Aetna Medicaid $89.56
Rate for Payer: BCBS Blue Traditional $81.06
Rate for Payer: HealthChoice Medicaid $145.02
Rate for Payer: Humana Medicaid $89.56
Rate for Payer: Oklahoma Complete Medicaid $89.56
Rate for Payer: Sooner Care Medicaid $89.56
Rate for Payer: TRICARE TRICARE $95.90
Rate for Payer: United Health Medicaid $67.13
Service Code CPT 97167
Hospital Charge Code 30
Hospital Revenue Code 430
Min. Negotiated Rate $67.13
Max. Negotiated Rate $145.02
Rate for Payer: Aetna Medicaid $89.56
Rate for Payer: BCBS Blue Traditional $81.06
Rate for Payer: Cash Price $89.56
Rate for Payer: HealthChoice Medicaid $145.02
Rate for Payer: Humana Medicaid $89.56
Rate for Payer: Oklahoma Complete Medicaid $89.56
Rate for Payer: Sooner Care Medicaid $89.56
Rate for Payer: TRICARE TRICARE $95.90
Rate for Payer: United Health Medicaid $67.13
Service Code CPT 97166
Hospital Charge Code 31
Hospital Revenue Code 430
Min. Negotiated Rate $67.13
Max. Negotiated Rate $145.02
Rate for Payer: Aetna Medicaid $89.56
Rate for Payer: BCBS Blue Traditional $81.06
Rate for Payer: HealthChoice Medicaid $145.02
Rate for Payer: Humana Medicaid $89.56
Rate for Payer: Oklahoma Complete Medicaid $89.56
Rate for Payer: Sooner Care Medicaid $89.56
Rate for Payer: TRICARE TRICARE $95.90
Rate for Payer: United Health Medicaid $67.13
Service Code CPT 97166
Hospital Charge Code 32
Hospital Revenue Code 430
Min. Negotiated Rate $67.13
Max. Negotiated Rate $145.02
Rate for Payer: Aetna Medicaid $89.56
Rate for Payer: BCBS Blue Traditional $81.06
Rate for Payer: Cash Price $89.56
Rate for Payer: HealthChoice Medicaid $145.02
Rate for Payer: Humana Medicaid $89.56
Rate for Payer: Oklahoma Complete Medicaid $89.56
Rate for Payer: Sooner Care Medicaid $89.56
Rate for Payer: TRICARE TRICARE $95.90
Rate for Payer: United Health Medicaid $67.13
Service Code CPT 97166
Hospital Charge Code 34
Hospital Revenue Code 430
Min. Negotiated Rate $67.13
Max. Negotiated Rate $145.02
Rate for Payer: Aetna Medicaid $89.56
Rate for Payer: BCBS Blue Traditional $81.06
Rate for Payer: Cash Price $89.56
Rate for Payer: HealthChoice Medicaid $145.02
Rate for Payer: Humana Medicaid $89.56
Rate for Payer: Oklahoma Complete Medicaid $89.56
Rate for Payer: Sooner Care Medicaid $89.56
Rate for Payer: TRICARE TRICARE $95.90
Rate for Payer: United Health Medicaid $67.13
Service Code CPT 97166
Hospital Charge Code 33
Hospital Revenue Code 430
Min. Negotiated Rate $67.13
Max. Negotiated Rate $145.02
Rate for Payer: Aetna Medicaid $89.56
Rate for Payer: BCBS Blue Traditional $81.06
Rate for Payer: HealthChoice Medicaid $145.02
Rate for Payer: Humana Medicaid $89.56
Rate for Payer: Oklahoma Complete Medicaid $89.56
Rate for Payer: Sooner Care Medicaid $89.56
Rate for Payer: TRICARE TRICARE $95.90
Rate for Payer: United Health Medicaid $67.13
Service Code CPT 97530
Hospital Charge Code 36
Hospital Revenue Code 430
Min. Negotiated Rate $24.50
Max. Negotiated Rate $52.92
Rate for Payer: Aetna Medicaid $32.02
Rate for Payer: BCBS Blue Traditional $31.88
Rate for Payer: Cash Price $32.02
Rate for Payer: HealthChoice Medicaid $52.92
Rate for Payer: Humana Medicaid $32.02
Rate for Payer: Oklahoma Complete Medicaid $32.02
Rate for Payer: Sooner Care Medicaid $32.02
Rate for Payer: TRICARE TRICARE $35.00
Rate for Payer: United Health Medicaid $24.50
Service Code CPT 97530
Hospital Charge Code 35
Hospital Revenue Code 430
Min. Negotiated Rate $24.50
Max. Negotiated Rate $42.92
Rate for Payer: Aetna Medicaid $32.02
Rate for Payer: BCBS Blue Traditional $31.88
Rate for Payer: HealthChoice Medicaid $42.92
Rate for Payer: Humana Medicaid $32.02
Rate for Payer: Oklahoma Complete Medicaid $32.02
Rate for Payer: Sooner Care Medicaid $32.02
Rate for Payer: TRICARE TRICARE $35.00
Rate for Payer: United Health Medicaid $24.50
Service Code CPT 99442
Hospital Charge Code 37
Min. Negotiated Rate $56.77
Max. Negotiated Rate $85.19
Rate for Payer: Aetna Medicaid $79.73
Rate for Payer: BCBS Blue Traditional $56.77
Rate for Payer: Cash Price $79.73
Rate for Payer: Humana Medicaid $79.73
Rate for Payer: Oklahoma Complete Medicaid $79.73
Rate for Payer: Sooner Care Medicaid $79.73
Rate for Payer: TRICARE TRICARE $85.19
Rate for Payer: United Health Medicaid $59.63
Service Code CPT 99443
Hospital Charge Code 38
Min. Negotiated Rate $83.79
Max. Negotiated Rate $120.25
Rate for Payer: Aetna Medicaid $113.10
Rate for Payer: BCBS Blue Traditional $83.79
Rate for Payer: Cash Price $113.10
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 $120.25
Rate for Payer: United Health Medicaid $84.17
Service Code CPT 99441
Hospital Charge Code 39
Min. Negotiated Rate $30.06
Max. Negotiated Rate $69.69
Rate for Payer: Aetna Medicaid $49.19
Rate for Payer: BCBS Blue Traditional $30.06
Rate for Payer: Cash Price $49.19
Rate for Payer: Humana Medicaid $49.19
Rate for Payer: Oklahoma Complete Medicaid $49.19
Rate for Payer: Sooner Care Medicaid $49.19
Rate for Payer: TRICARE TRICARE $52.42
Rate for Payer: United Health Medicaid $69.69
Service Code CPT 97530
Hospital Charge Code 42
Hospital Revenue Code 420
Min. Negotiated Rate $24.50
Max. Negotiated Rate $42.92
Rate for Payer: Aetna Medicaid $32.02
Rate for Payer: BCBS Blue Traditional $31.88
Rate for Payer: Cash Price $32.20
Rate for Payer: HealthChoice Medicaid $42.92
Rate for Payer: Humana Medicaid $32.02
Rate for Payer: Oklahoma Complete Medicaid $32.02
Rate for Payer: Sooner Care Medicaid $32.02
Rate for Payer: TRICARE TRICARE $35.00
Rate for Payer: United Health Medicaid $24.50
Service Code CPT 97110
Hospital Charge Code 40
Hospital Revenue Code 420
Min. Negotiated Rate $19.70
Max. Negotiated Rate $42.53
Rate for Payer: Aetna Medicaid $25.94
Rate for Payer: BCBS Blue Traditional $24.90
Rate for Payer: Cash Price $32.02
Rate for Payer: HealthChoice Medicaid $42.53
Rate for Payer: Humana Medicaid $25.94
Rate for Payer: Oklahoma Complete Medicaid $25.94
Rate for Payer: Sooner Care Medicaid $25.94
Rate for Payer: TRICARE TRICARE $30.00
Rate for Payer: United Health Medicaid $19.70
Service Code CPT 97530
Hospital Charge Code 41
Hospital Revenue Code 420
Min. Negotiated Rate $24.50
Max. Negotiated Rate $42.92
Rate for Payer: Aetna Medicaid $32.02
Rate for Payer: BCBS Blue Traditional $31.88
Rate for Payer: Cash Price $32.02
Rate for Payer: HealthChoice Medicaid $42.92
Rate for Payer: Humana Medicaid $32.02
Rate for Payer: Oklahoma Complete Medicaid $32.02
Rate for Payer: Sooner Care Medicaid $32.02
Rate for Payer: TRICARE TRICARE $35.00
Rate for Payer: United Health Medicaid $24.50
Service Code CPT 97163
Hospital Charge Code 43
Hospital Revenue Code 420
Min. Negotiated Rate $67.13
Max. Negotiated Rate $145.02
Rate for Payer: Aetna Medicaid $88.72
Rate for Payer: BCBS Blue Traditional $83.49
Rate for Payer: Cash Price $88.72
Rate for Payer: HealthChoice Medicaid $145.02
Rate for Payer: Humana Medicaid $88.72
Rate for Payer: Oklahoma Complete Medicaid $88.72
Rate for Payer: Sooner Care Medicaid $88.72
Rate for Payer: TRICARE TRICARE $95.90
Rate for Payer: United Health Medicaid $67.13
Service Code CPT 97163
Hospital Charge Code 44
Hospital Revenue Code 420
Min. Negotiated Rate $67.13
Max. Negotiated Rate $145.02
Rate for Payer: Aetna Medicaid $88.72
Rate for Payer: BCBS Blue Traditional $83.49
Rate for Payer: HealthChoice Medicaid $145.02
Rate for Payer: Humana Medicaid $88.72
Rate for Payer: Oklahoma Complete Medicaid $88.72
Rate for Payer: Sooner Care Medicaid $88.72
Rate for Payer: TRICARE TRICARE $95.90
Rate for Payer: United Health Medicaid $67.13
Service Code CPT 97161
Hospital Charge Code 45
Hospital Revenue Code 420
Min. Negotiated Rate $67.13
Max. Negotiated Rate $145.02
Rate for Payer: Aetna Medicaid $88.72
Rate for Payer: BCBS Blue Traditional $83.49
Rate for Payer: Cash Price $88.72
Rate for Payer: HealthChoice Medicaid $145.02
Rate for Payer: Humana Medicaid $88.72
Rate for Payer: Oklahoma Complete Medicaid $88.72
Rate for Payer: Sooner Care Medicaid $88.72
Rate for Payer: TRICARE TRICARE $95.90
Rate for Payer: United Health Medicaid $67.13
Service Code CPT 97161
Hospital Charge Code 46
Hospital Revenue Code 420
Min. Negotiated Rate $67.13
Max. Negotiated Rate $145.02
Rate for Payer: Aetna Medicaid $88.72
Rate for Payer: BCBS Blue Traditional $83.49
Rate for Payer: Cash Price $150.00
Rate for Payer: HealthChoice Medicaid $145.02
Rate for Payer: Humana Medicaid $88.72
Rate for Payer: Oklahoma Complete Medicaid $88.72
Rate for Payer: Sooner Care Medicaid $88.72
Rate for Payer: TRICARE TRICARE $95.90
Rate for Payer: United Health Medicaid $67.13
Service Code CPT 97162
Hospital Charge Code 47
Hospital Revenue Code 420
Min. Negotiated Rate $67.13
Max. Negotiated Rate $145.02
Rate for Payer: Sooner Care Medicaid $88.72
Rate for Payer: TRICARE TRICARE $95.90
Rate for Payer: United Health Medicaid $67.13
Rate for Payer: Aetna Medicaid $88.72
Rate for Payer: BCBS Blue Traditional $83.49
Rate for Payer: Cash Price $88.72
Rate for Payer: HealthChoice Medicaid $145.02
Rate for Payer: Humana Medicaid $88.72
Rate for Payer: Oklahoma Complete Medicaid $88.72
Service Code CPT 97162
Hospital Charge Code 48
Hospital Revenue Code 420
Min. Negotiated Rate $67.13
Max. Negotiated Rate $145.02
Rate for Payer: Aetna Medicaid $88.72
Rate for Payer: BCBS Blue Traditional $83.49
Rate for Payer: Cash Price $150.00
Rate for Payer: HealthChoice Medicaid $145.02
Rate for Payer: Humana Medicaid $88.72
Rate for Payer: Oklahoma Complete Medicaid $88.72
Rate for Payer: Sooner Care Medicaid $88.72
Rate for Payer: TRICARE TRICARE $95.90
Rate for Payer: United Health Medicaid $67.13
Service Code CPT 90791
Hospital Charge Code 49
Min. Negotiated Rate $118.62
Max. Negotiated Rate $254.98
Rate for Payer: Aetna Medicaid $156.37
Rate for Payer: BCBS Blue Traditional $133.28
Rate for Payer: Cash Price $156.37
Rate for Payer: HealthChoice Medicaid $254.98
Rate for Payer: Humana Medicaid $156.37
Rate for Payer: Oklahoma Complete Medicaid $156.37
Rate for Payer: Sooner Care Medicaid $156.37
Rate for Payer: TRICARE TRICARE $169.46
Rate for Payer: United Health Medicaid $118.62
Service Code CPT 96137
Hospital Charge Code 50
Min. Negotiated Rate $16.09
Max. Negotiated Rate $55.30
Rate for Payer: Aetna Medicaid $32.92
Rate for Payer: BCBS Blue Traditional $16.09
Rate for Payer: Cash Price $32.92
Rate for Payer: HealthChoice Medicaid $55.30
Rate for Payer: Humana Medicaid $32.92
Rate for Payer: Oklahoma Complete Medicaid $32.92
Rate for Payer: Sooner Care Medicaid $32.92
Rate for Payer: TRICARE TRICARE $36.58
Rate for Payer: United Health Medicaid $25.61