CMS Price Transparency Data

Psychological testing evaluation

Facility: Grossmont Hospital

Billing Code: 96136 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 96136
Insurance Median: $312
Cash Discount Price: $368
vs. Medicare Baseline: 2.30x Medicare

The contracted insurance negotiated median rate for a Psychological testing evaluation at Grossmont Hospital is $312. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $368. Compared to the federal Medicare reimbursement reference rate of $135.93, this hospital’s rate is 2.30x the Medicare baseline. Located in 5555 Grossmont Center Drive Box 58, La Mesa, CA.

Cash / Self-Pay

$368

Average discount available for prompt cash payment at this facility.

Insurance Median

$312

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$135.93

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $135.93 (100%)

Cash / Self-Pay: $368 (271%)

Insurance Median: $312 (230%)

Cash: $368 (271% of Medicare)

Ins. Median: $312 (230% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $135.93 as the cost baseline. Rates below the baseline represent excellent value. In-network commercial rates commonly hover around 150% - 250% of Medicare, while rates exceeding 300% are elevated. Hover over the green and blue markers to view detailed calculations.

Elevated Commercial Rate Alert (Value-Gap)

The negotiated rate at this facility is 230% of the Medicare baseline (a markup of 130%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Consult Patient Advocate

Out-of-Pocket Cost Estimator

Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash rate.

Billing Status

Remaining Deductible ($)

Your Coinsurance Rate (%)

Input your details and click calculate to compare out-of-pocket costs.

Commercial Insurance Negotiated Rates

Negotiated contract ranges established by major commercial carriers at this facility.

Carrier / Plan Group	Contract Rate Range	vs. Medicare Reference
Community Health Group	$86 - $295	63%
Blue Cross Blue Shield	$146 - $442	107%
Blue Shield	$146 - $344	107%
Health Net	$146 - $368	107%
Indian Health Council	$146	107%
UnitedHealthcare	$167 - $313	123%
Medicare (plans)	$235	173%
Aetna	$295 - $368	217%
Epic Americas	$329	242%
San Diego Pace	$331 - $339	244%
Managed Health Network	$344	253%
Molina	$344 - $393	253%
Allianz Global Assistance	$368 - $18,827	271%
County Medical Services	$368	271%
Kaiser	$393	289%
Medi-Cal	$393	289%
Multiplan	$393	289%

Self-Pay Upfront Cash Action Plan

Request a "Self-Pay classification" with the billing desk before receiving care.
Ask for a written "Prompt-Pay Discount" agreement quoting the price of $368.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 96136.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Grossmont Hospital is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 96136.
Confirm the specific physician or imaging center is also in-network (not just the hospital building).
Audit your Explanation of Benefits (EOB) against the final itemized hospital invoice.