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California rates for HCPCS 97130

Therapeutic interventions that focus on cognitive function (eg, attention, memory, reasoning, executive function, problem solving, and/or pragmatic functioning) and compensatory strategies to manage the performance of an activity (eg, managing time or schedules, initiating, organizing, and sequencing tasks), direct (one-on-one) patient contact; each additional 15 minutes (List separately in addition to code for primary procedure)

Facilitymedian $21 · 10th–90th $14–$330%10%10th90th$21Professionalmedian $20 · 10th–90th $13–$720%10%10th90th$20$10.0$20.0$50.0$100.0$200.0$500.0

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$15.14 / $15.85 / $112.20
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$12.88 / $16.98 / $91.20
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$30.90 / $30.90 / $33.11
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$17.78 / $36.31 / $74.13
Blue Shield
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$36.31 / $36.31 / $36.31
Blue Shield
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$19.05 / $26.30 / $54.95
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$14.79 / $23.44 / $56.23
Contra Costa Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$19.95 / $23.99 / $32.36
Kaiser Permanente
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$16.22 / $19.50 / $29.51
Lucent Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$134.90 / $134.90 / $134.90
Lucent Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$138.04 / $169.82 / $169.82
Optum
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$54.95 / $54.95 / $70.79
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$13.80 / $19.95 / $29.51
Providence
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$15.14 / $27.54 / $58.88
Sutter Health Plus
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$74.13 / $74.13 / $74.13
The Alliance
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$16.98 / $22.39 / $29.51
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$24.55 / $24.55 / $24.55
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$18.20 / $23.44 / $64.57