CMS Price Transparency Data

Psychological testing evaluation

Facility: Craig Hospital

Billing Code: 96136 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 96136
Insurance Median: $492
Cash Discount Price: $272
vs. Medicare Baseline: 3.62x Medicare

The contracted insurance negotiated median rate for a Psychological testing evaluation at Craig Hospital is $492. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $272. Compared to the federal Medicare reimbursement reference rate of $135.93, this hospital’s rate is 3.62x the Medicare baseline. Located in 3425 S Clarkson St, Englewood, CO.

Cash / Self-Pay

$272

Average discount available for prompt cash payment at this facility.

Insurance Median

$492

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: $272 (200%)

Insurance Median: $492 (362%)

Cash: $272 (200% of Medicare)

Ins. Median: $492 (362% 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 362% of the Medicare baseline (a markup of 262%). 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
Veterans Administration	$109	80%
Cms	$128	94%
UnitedHealthcare	$128 - $356	94%
Cigna	$362	266%
Kaiser	$372	274%
Blue Cross Blue Shield	$380	280%
Carisk Outcomes	$394	290%
Zenith	$427	314%
Aetna	$446	328%
Corvel Worker'S Comp	$459	338%
Liberty Mutual Worker'S Comp	$459	338%
Paradigm	$459	338%
Rocky Mountain Health Plan	$479	352%
Midwest Employers Casualty	$486	358%
Coventry/First Health	$492	362%
Fcci Worker'S Comp	$492	362%
Geha/Ppo Usa	$492	362%
Great-West Healthcare	$492	362%
Prime Health Services	$499	367%
First Choice Health	$512	377%
Multiplan/Phcs	$518	381%
Focus Worker'S Comp	$525	386%
General Reinsurance	$525 - $558	386%
Provider Network Of America	$525	386%
Three Rivers Provider Network	$525 - $538	386%
Wyoming Worker'S Comp	$525	386%
Allstate	$558	411%
Tricare	$558	411%
National Provider Network	$591	435%
Up & Up	$591	435%

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 $272.
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 Craig 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.