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Pennsylvania 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 $32 · 10th–90th $28–$4070%10%20%10th90th$32Professionalmedian $16 · 10th–90th $13–$250%20%10th90th$16$2.0$5.0$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
$27.54 / $32.36 / $407.38
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$12.88 / $15.14 / $22.91
AmeriHealth
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$16.22 / $16.22 / $16.22
Capital Blue Cross
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$20.42 / $22.39 / $38.02
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$35.48 / $75.86 / $125.89
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$12.59 / $23.99 / $42.66
Emblem Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$20.42 / $30.20 / $44.67
Geisinger
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$16.22 / $22.91 / $41.69
Independence Blue Cross
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$16.22 / $16.22 / $16.22
Martin's Point
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$27.54 / $28.18 / $32.36
Martin's Point
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$12.88 / $15.14 / $25.12
Oscar Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$25.12 / $36.31 / $39.81
UPMC Health Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$15.14 / $21.88 / $31.62
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$17.38 / $22.91 / $35.48