J.D. McCarty Center

All Charges

Charge

Type

Price

Inpatient Room and Board

Facility IP

$2,325.00

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

Occupational Sensory Integrative Therapy

Facility IP

$75.00

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

Occupational Sensory Integrative Therapy

Facility OP

$75.00

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

Occupational Therapy Evaluation (High)

Facility IP

$150.00

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

Occupational Therapy Evaluation (High)

Facility OP

$150.00

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

Occupational Therapy Evaluation (Low)

Facility IP

$150.00

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

Occupational Therapy Evaluation (Low)

Facility OP

$150.00

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

Occupational Therapy Evaluation (Medium)

Facility IP

$150.00

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

Occupational Therapy Evaluation (Medium)

Facility OP

$150.00

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

Occuptaional Tharapy

Facility OP

$50.00

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

Occuptaional Tharapy

Facility IP

$50.00

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

Online Digital Evaluation and Management (11 - 20 Minutes)

Professional

$95.00

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

Online Digital Evaluation and Management (21 + Minutes)

Professional

$135.00

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

Online Digital Evaluation and Management (5 - 10 Minutes)

Professional

$60.00

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

Physical Therapy

Facility IP

$50.00

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

Physical Therapy

Facility IP

$50.00

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

Physical Therapy

Facility IP

$50.00

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

Physical Therapy Evaluation (High)

Facility IP

$150.00

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

Physical Therapy Evaluation (High)

Facility OP

$150.00

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

Physical Therapy Evaluation (Low)

Facility OP

$150.00

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

Physical Therapy Evaluation (Low)

Facility IP

$150.00

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

Physical Therapy Evaluation (Medium)

Facility OP

$150.00

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

Physical Therapy Evaluation (Medium)

Facility IP

$150.00

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

Psychiatric Diagnosic Evaluation

Professional

$200.00

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

Psychological and Neuro Testing

Professional

$45.00

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

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