CMS Price Transparency Data

Psychological testing by technician

Facility: Valley West Community Hospital

Billing Code: 96138 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 96138
Insurance Median: $660
Cash Discount Price: $921
vs. Medicare Baseline: 1.45x Medicare

The contracted insurance negotiated median rate for a Psychological testing by technician at Valley West Community Hospital is $660. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $921. Compared to the federal Medicare reimbursement reference rate of $456.4, this hospital’s rate is 1.45x the Medicare baseline. Located in 11 East Pleasant Avenue, Sandwich, IL.

Cash / Self-Pay

$921

Average discount available for prompt cash payment at this facility.

Insurance Median

$660

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$456.4

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $456.4 (100%)

Cash / Self-Pay: $921 (202%)

Insurance Median: $660 (145%)

Cash: $921 (202% of Medicare)

Ins. Median: $660 (145% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $456.4 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	$91 - $857	20%
Cigna	$91 - $635	20%
Countycare Il Cook Co [1607]	$91	20%
Family Health Network Hmo [1610]	$91	20%
Medicaid / KanCare	$91	20%
Meridian Health Plan Hmo [1604]	$91	20%
Global Excel [1712]	$250	55%
Humana	$250	55%
Aetna	$334 - $911	73%
Health'S Finest Network [126]	$592 - $1,118	130%
UnitedHealthcare	$660 - $1,315	145%
The Alliance [1703]	$715	157%
Choicecare [177]	$886	194%
Healthlink [125]	$986	216%
Multiplan/Phcs [142]	$1,052 - $1,315	230%
First Health Plan [6034]	$1,315	288%

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 $921.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 96138.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Valley West Community Hospital is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 96138.
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.