J.D. McCarty Center

All Charges

Charge

Type

Price

Psychological and Neuro Testing Evaluation

Professional

$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

$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

$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

Price Transparency.