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Pennsylvania rates for HCPCS 97158

Group adaptive behavior treatment with protocol modification, administered by physician or other qualified health care professional, face-to-face with multiple patients, each 15 minutes

Facilitymedian $141 · 10th–90th $4–$2510%10%20%10th90th$141Professionalmedian $19 · 10th–90th $10–$230%20%40%10th90th$19$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
$33.11 / $239.88 / $251.19
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$15.14 / $19.05 / $23.99
Capital Blue Cross
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$5.62 / $5.62 / $5.62
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$8.32 / $8.32 / $8.32
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$5.62 / $12.02 / $15.14
Emblem Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$12.02 / $12.02 / $12.02
Geisinger
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$4.27 / $4.27 / $4.57
Geisinger
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$3.72 / $5.01 / $8.71
Highmark BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$5.62 / $5.62 / $5.62
Independence Blue Cross
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$213.80 / $213.80 / $213.80
Martin's Point
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$22.91 / $22.91 / $30.90
Martin's Point
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$16.98 / $19.05 / $23.99
Optum
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$12.88 / $12.88 / $12.88
Oscar Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$3.98 / $3.98 / $11.22
UPMC Health Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1.86 / $1.86 / $10.00
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$4.37 / $6.17 / $11.22