Psychological testing evaluation
Facility: St. Catherine Hospital - Garden City
Billing Code: 96136 (CPT)
- CPT Billing Code: 96136
- Insurance Median: $22
- Cash Discount Price: Unavailable
- vs. Medicare Baseline: 0.16x Medicare
Average discount available for prompt cash payment at this facility.
Median negotiated contract rate across all mapped commercial carriers.
Standard federal government reimbursement rate for this code.
Visual Cost Comparison vs. 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.
Commercial Insurance Negotiated Rates
Negotiated contract ranges established by major commercial carriers at this facility.
| Carrier / Plan Group | Contract Rate Range | vs. Medicare Reference |
|---|---|---|
| Cigna | $21 - $22 | 15% |
| Medicare (plans) | $21 - $22 | 15% |
| Aetna | $21 - $22 | 15% |
| Kaiser | $21 - $22 | 15% |
| Humana | $21 - $22 | 15% |
| UnitedHealthcare | $21 - $22 | 15% |
| Kansas Health | $21 | 15% |
| Blue Cross Blue Shield | $21 - $150 | 15% |
| Devoted Health | $22 | 16% |
| Innovage | $22 | 16% |
Consumer Guidance & Cost Commentary
For the CPT code 96136, Psychological testing evaluation, at St. Catherine Hospital in Garden City, Kansas, the negotiated rates across major payers like Cigna, Medicare, and Aetna range from $21 to $22. This aligns closely with the state average for this service, which is also $21. While commercial insurance contracts typically cap costs at these negotiated levels, patients should be aware that cash prices for this procedure are not listed in the current data. In scenarios where a patient has a high deductible or limited insurance coverage, paying the cash price directly can sometimes result in lower out-of-pocket costs compared to the insurance negotiated rate, provided the facility offers a self-pay discount. It is advisable to contact the hospital directly to confirm their specific self-pay or prompt-pay rates before scheduling, as these upfront discounts can significantly reduce the final bill.
The Medicare benchmark for this service is $135.93, which serves as a critical baseline for evaluating pricing fairness. Commercial negotiated rates of $21 to $22 are substantially lower than the Medicare amount, indicating that the facility is charging well below the federal cost-based standard for this procedure. This pricing structure suggests that the facility is not applying a significant markup relative to the government rate, which is often a point of contention in healthcare billing disputes. However, patients should remain vigilant regarding balance billing if they receive care from out-of-network providers, as federal protections under the No Surprises Act may prevent unexpected charges for emergency services or non-emergency care at in-network facilities. To ensure accuracy, consumers should request a full itemized bill rather than accepting a summary invoice, allowing them to verify that all charges correspond to services actually rendered and