|
Psychological and Neuro Testing
|
Professional
|
Both
|
$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
|
|
|
Psychological and Neuro Testing Evaluation
|
Professional
|
Both
|
$100.00
|
|
|
Service Code
|
CPT 96131
|
| Hospital Charge Code |
51
|
| Min. Negotiated Rate |
$59.02 |
| Max. Negotiated Rate |
$127.50 |
| Rate for Payer: Aetna Medicaid |
$77.91
|
| Rate for Payer: BCBS Blue Traditional |
$69.52
|
| Rate for Payer: Cash Price |
$77.91
|
| Rate for Payer: HealthChoice Medicaid |
$127.50
|
| Rate for Payer: Humana Medicaid |
$77.91
|
| Rate for Payer: Oklahoma Complete Medicaid |
$77.91
|
| Rate for Payer: Sooner Care Medicaid |
$77.91
|
| Rate for Payer: TRICARE TRICARE |
$84.31
|
| Rate for Payer: United Health Medicaid |
$59.02
|
|
|
Psychological Testing
|
Professional
|
Both
|
$150.00
|
|
|
Service Code
|
CPT 96130
|
| Hospital Charge Code |
52
|
| Min. Negotiated Rate |
$81.33 |
| Max. Negotiated Rate |
$490.11 |
| Rate for Payer: Aetna Medicaid |
$108.38
|
| Rate for Payer: BCBS Blue Traditional |
$91.99
|
| Rate for Payer: Cash Price |
$108.38
|
| Rate for Payer: HealthChoice Medicaid |
$490.11
|
| Rate for Payer: Humana Medicaid |
$108.38
|
| Rate for Payer: Oklahoma Complete Medicaid |
$108.38
|
| Rate for Payer: Sooner Care Medicaid |
$108.38
|
| Rate for Payer: TRICARE TRICARE |
$116.18
|
| Rate for Payer: United Health Medicaid |
$81.33
|
|
|
Simple Cranial Nerve Neurostimulator
|
Professional
|
Both
|
$60.00
|
|
|
Service Code
|
CPT 95976
|
| Hospital Charge Code |
53
|
| Min. Negotiated Rate |
$26.63 |
| Max. Negotiated Rate |
$61.25 |
| Rate for Payer: Aetna Medicaid |
$34.25
|
| Rate for Payer: BCBS Blue Traditional |
$33.09
|
| Rate for Payer: Cash Price |
$34.25
|
| Rate for Payer: HealthChoice Medicaid |
$61.25
|
| Rate for Payer: Humana Medicaid |
$34.25
|
| Rate for Payer: Oklahoma Complete Medicaid |
$34.25
|
| Rate for Payer: Sooner Care Medicaid |
$34.25
|
| Rate for Payer: TRICARE TRICARE |
$38.04
|
| Rate for Payer: United Health Medicaid |
$26.63
|
|
|
Speech Therapy
|
Facility
|
IP
|
$84.00
|
|
|
Service Code
|
CPT 92507
|
| Hospital Charge Code |
54
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$51.35 |
| Max. Negotiated Rate |
$73.36 |
| Rate for Payer: Aetna Medicaid |
$67.94
|
| Rate for Payer: BCBS Blue Traditional |
$64.36
|
| Rate for Payer: HealthChoice Medicaid |
$64.61
|
| Rate for Payer: Humana Medicaid |
$67.94
|
| Rate for Payer: Oklahoma Complete Medicaid |
$67.94
|
| Rate for Payer: Sooner Care Medicaid |
$67.94
|
| Rate for Payer: TRICARE TRICARE |
$73.36
|
| Rate for Payer: United Health Medicaid |
$51.35
|
|
|
Speech Therapy
|
Facility
|
OP
|
$84.00
|
|
|
Service Code
|
CPT 92507
|
| Hospital Charge Code |
55
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$51.35 |
| Max. Negotiated Rate |
$73.36 |
| Rate for Payer: Aetna Medicaid |
$67.94
|
| Rate for Payer: BCBS Blue Traditional |
$64.36
|
| Rate for Payer: Cash Price |
$67.94
|
| Rate for Payer: HealthChoice Medicaid |
$64.61
|
| Rate for Payer: Humana Medicaid |
$67.94
|
| Rate for Payer: Oklahoma Complete Medicaid |
$67.94
|
| Rate for Payer: Sooner Care Medicaid |
$67.94
|
| Rate for Payer: TRICARE TRICARE |
$73.36
|
| Rate for Payer: United Health Medicaid |
$51.35
|
|
|
Speech Therapy Evaluation
|
Facility
|
OP
|
$250.00
|
|
|
Service Code
|
CPT 92523
|
| Hospital Charge Code |
57
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$152.88 |
| Max. Negotiated Rate |
$218.40 |
| Rate for Payer: Aetna Medicaid |
$202.75
|
| Rate for Payer: BCBS Blue Traditional |
$193.70
|
| Rate for Payer: Cash Price |
$250.00
|
| Rate for Payer: HealthChoice Medicaid |
$161.18
|
| Rate for Payer: Humana Medicaid |
$202.75
|
| Rate for Payer: Oklahoma Complete Medicaid |
$202.75
|
| Rate for Payer: Sooner Care Medicaid |
$202.75
|
| Rate for Payer: TRICARE TRICARE |
$218.40
|
| Rate for Payer: United Health Medicaid |
$152.88
|
|
|
Speech Therapy Evaluation
|
Facility
|
IP
|
$250.00
|
|
|
Service Code
|
CPT 92523
|
| Hospital Charge Code |
56
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$152.88 |
| Max. Negotiated Rate |
$218.40 |
| Rate for Payer: Aetna Medicaid |
$202.75
|
| Rate for Payer: BCBS Blue Traditional |
$193.70
|
| Rate for Payer: Cash Price |
$202.75
|
| Rate for Payer: HealthChoice Medicaid |
$161.18
|
| Rate for Payer: Humana Medicaid |
$202.75
|
| Rate for Payer: Oklahoma Complete Medicaid |
$202.75
|
| Rate for Payer: Sooner Care Medicaid |
$202.75
|
| Rate for Payer: TRICARE TRICARE |
$218.40
|
| Rate for Payer: United Health Medicaid |
$152.88
|
|
