Breast CT scan without contrast dye at Fairview Maple Grove Surgery Center

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 BREAST W/3D UNI C-

Maple Grove, MN

See all hospitals reporting CPT 0633T →

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Pricing by billing methodology

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How this price compares nationally

Fairview Maple Grove Surgery Center’s median price of $137 is 8% below the median hospital's median price ($149), higher than 46% of the 1,262 hospitals reporting CPT 0633T. The highlighted bar is where this hospital falls; shaded is the middle 50% of hospitals.

Payers reporting CPT 0633T at Fairview Maple Grove Surgery Center

Negotiated rates from the hospital’s own file: 5 payers, 19 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	UnitedHealthcare medicare advantage fee schedule · outpatient	$57	$57	—	—	—	$57 – $57
2	Blue Cross Blue Shield medicare advantage fee schedule · outpatient	$60	$60	—	—	—	$60 – $60
3	Ucare ifp with fairview fee schedule · outpatient	$99	$99	—	—	—	$99 – $99
4	Cigna commercial fee schedule · outpatient	$118	$118	$10	9%	—	$108 – $128
5	Ucare ifp fee schedule · outpatient	$132	$132	—	—	—	$132 – $132
6	Medica ma non-snp fee schedule · both	$131	$138	$54	39%	—	$76 – $207
7	Medica ma snp fee schedule · both	$131	$138	$54	39%	—	$76 – $207
8	Medica prime solution fee schedule · both	$131	$138	$54	39%	—	$76 – $207
9	Medica vantage fee schedule · both	$131	$138	$54	39%	—	$76 – $207
10	Blue Cross Blue Shield federal fee schedule · both	$192	$206	$79	38%	—	$117 – $308
11	Blue Cross Blue Shield commercial fee schedule · both	$195	$209	$80	38%	—	$119 – $314
12	Blue Cross Blue Shield medicaid fee schedule · outpatient	$224	$224	—	—	—	$224 – $224
13	UnitedHealthcare commercial fee schedule · both	$339	$226	$160	71%	—	$0 – $339
14	Medica bold fee schedule · both	$237	$249	$97	39%	—	$137 – $373
15	Medica choice without / elect fee schedule · both	$263	$277	$108	39%	—	$152 – $415
16	Medica city of st paul / essential uplan fee schedule · both	$263	$277	$108	39%	—	$152 – $415
17	Medica choice with fee schedule · both	$272	$286	$111	39%	—	$157 – $429
18	Blue Cross Blue Shield federal fee schedule · outpatient	$370	$370	—	—	—	$370 – $370
19	Blue Cross Blue Shield commercial fee schedule · outpatient	$377	$377	—	—	—	$377 – $377

Last updated: May 18, 2026

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See Breast CT scan without contrast dye pricing across every hospital in the network reporting it, or ask Claude or any MCP client directly — see how to connect.