CMS Price Transparency Data

Psychological testing evaluation

Facility: Adventist Health Sonora

Billing Code: 96136 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 96136
Insurance Median: $49
Cash Discount Price: $14
vs. Medicare Baseline: 0.36x Medicare

The contracted insurance negotiated median rate for a Psychological testing evaluation at Adventist Health Sonora is $49. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $14. Compared to the federal Medicare reimbursement reference rate of $135.93, this hospital’s rate is 0.36x the Medicare baseline. Located in 1000 Greenley Road, Sonora, CA.

Cash / Self-Pay

$14

Average discount available for prompt cash payment at this facility.

Insurance Median

$49

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: $14 (10%)

Insurance Median: $49 (36%)

Cash: $14 (10% of Medicare)

Ins. Median: $49 (36% 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.

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
Blue Shield Mcare	$22	16%
Central Ca Alliance Mcr Adv Profee Only	$22	16%
Healthnet Mcr Adv	$22	16%
Tricare	$22	16%
UnitedHealthcare	$22 - $92	16%
Ah Employee Health Plan - All Plans	$24	18%
Cigna	$27	20%
Greatwest Oa/Pos/Hmo	$28	21%
Greatwest Ppo - All Other Plans	$28	21%
Western Growers/Pinnacle - All Plans	$30	22%
Healthnet - All Other Plans	$31	23%
Aetna	$38	28%
Bc Mcal	$42	31%
Celtic Ca Hlth Well Mcal - All Plans	$42	31%
Central Ca Alliance Mcal	$42	31%
Healthnet Mcal	$42	31%
Medi-Cal	$42	31%
Beech Street- All Plans	$51 - $96	38%
Trpn - Three Rivers Ppo - All Plans	$51 - $96	38%
Central Ca Alliance Ccs Mcal	$57 - $63	42%
Central Ca Alliance Chdp Mcal	$57 - $84	42%
Central Ca Alliance Comm Profee Only-All Other Pla	$57 - $63	42%
Blue Shield Epn	$71	52%
Blue Shield - All Other Plans	$75	55%
Bc Mcs	$205	151%
Bc Non-Mcs - All Other Plans	$205	151%

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 $14.
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 Adventist Health Sonora 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.