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Illinois 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 $36 · 10th–90th $17–$1950%20%10th90th$36Professionalmedian $20 · 10th–90th $13–$250%10%10th90th$20$10.0$20.0$50.0$100.0$200.0

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
$16.98 / $36.31 / $194.98
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$12.88 / $15.85 / $23.99
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$22.39 / $77.62 / $77.62
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$19.05 / $22.39 / $25.12
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$35.48 / $35.48 / $70.79
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$13.49 / $26.30 / $40.74
Hally Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$18.20 / $28.84 / $93.33
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$32.36 / $32.36 / $33.11
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$20.42 / $20.42 / $46.77
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$18.20 / $20.89 / $33.11