CMS Price Transparency Data

Psychological testing evaluation

Facility: Alton Memorial Hospital

Billing Code: 96136 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 96136
Insurance Median: $164
Cash Discount Price: $131
vs. Medicare Baseline: 1.21x Medicare

The contracted insurance negotiated median rate for a Psychological testing evaluation at Alton Memorial Hospital is $164. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $131. Compared to the federal Medicare reimbursement reference rate of $135.93, this hospital’s rate is 1.21x the Medicare baseline. Located in One Memorial Drive, Alton, IL.

Cash / Self-Pay

$131

Average discount available for prompt cash payment at this facility.

Insurance Median

$164

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: $131 (96%)

Insurance Median: $164 (121%)

Cash: $131 (96% of Medicare)

Ins. Median: $164 (121% 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 Cross Blue Shield	$100 - $191	74%
Cigna	$115	85%
Consociate [478]	$118	87%
Sarah Bush Lincoln [636]	$118	87%
Cox Health Systems Insurance Company [220]	$120	88%
Humana	$122	90%
Allied Benefits [498]	$127 - $251	93%
Hope Trust [806]	$127	93%
Healthcare Sol Mercy [609]	$164	121%
Med-Pay [480]	$164	121%
Medica [661]	$175	129%
Phcs [244]	$175	129%
Healthscope Benefits [258]	$192	141%
UnitedHealthcare	$192	141%
Aetna	$251	185%
Coresource [497]	$251	185%
Fmh Benefit Service Inc [222]	$251	185%
Mail Handlers [495]	$251	185%

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 $131.
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 Alton Memorial 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.