J.D. McCarty Center

All Charges

Charge

Type

Price

Adaptive Behavior Assessment Procedure

Professional

$45.00

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

Applied Behavior Analysis (BCBA/BCABA Treatment)

Professional

$45.00

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

Applied Behavior Analysis (Parent Training)

Professional

$45.00

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

Applied Behavior Analysis (RBT Treatment)

Professional

$35.00

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

Complex Cranial Nerve Neurostimulator

Professional

$70.00

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

Electric Analysis of Implanted Neurostimulator

Professional

$75.00

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

Established Outpatient (Level 1)

Professional

$40.00

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

Established Outpatient (Level 2)

Professional

$65.00

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

Established Outpatient (Level 3)

Professional

$95.00

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

Established Outpatient (Level 4)

Professional

$150.00

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

Established Outpatient (Level 5)

Professional

$180.00

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

Feeding and Swallowing Evaluation

Facility IP

$150.00

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

Feeding and Swallowing Evaluation

Facility OP

$150.00

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

Feeding and Swallowing Therapy

Facility IP

$120.00

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

Feeding and Swallowing Therapy

Facility OP

$120.00

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

Initail Outpatient Encounter (Level 5)

Professional

$225.00

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

Initial Inpatient Enconter (Level 3)

Professional

$200.00

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

Initial Inpatient Encounter (Level 1)

Professional

$150.00

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

Initial Inpatient Encounter (Level 2)

Professional

$175.00

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

Initial Outpatient Encouner (Level 2)

Professional

$75.00

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

Initial Outpatient Encounter (Level 4)

Professional

$175.00

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

Initial Outpatinet Encounter (Level 3)

Professional

$105.00

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

Inpatient Hospital Care (Level 1)

Professional

$60.00

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

Inpatient Hospital Care (Level 2)

Professional

$75.00

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

Inpatient Hospital Care (Level 3)

Professional

$120.00

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

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All Charges