Psychological testing by technician
Facility: Kansas City Orthopaedic Institute
Billing Code: 96138 (CPT)
- CPT Billing Code: 96138
- Insurance Median: $919
- Cash Discount Price: Unavailable
- vs. Medicare Baseline: 2.01x 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 $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.
Elevated Commercial Rate Alert (Value-Gap)
The negotiated rate at this facility is 201% of the Medicare baseline (a markup of 101%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.
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 |
|---|---|---|
| UnitedHealthcare | $354 | 78% |
| Aetna | $354 | 78% |
| Cigna | $375 | 82% |
| Blue Cross Blue Shield | $919 | 201% |
Consumer Guidance & Cost Commentary
For the CPT code 96138, "Psychological testing by technician," the Kansas City Orthopaedic Institute in Leawood, KS, has a negotiated rate of $919.00, which is significantly higher than the state average of $456.40 (Medicare amount). While this facility is an Acute Care Hospital owned by a physician group, the data indicates that cash and median paid rates are not available for this specific service. Because commercial insurance rates often include administrative overhead and contract markups that can inflate prices by 20% to 40% above the true cost of care, patients with high-deductible plans might find that paying the cash price directly could result in lower out-of-pocket costs if the insurance negotiated rate exceeds the cash price. However, since cash rates are not listed, patients should verify current self-pay or prompt-pay discounts directly with the hospital before scheduling, as these upfront payment incentives can bypass costly claims processing and reduce overall expenses.
When reviewing this bill, it is important to understand that the $919.00 negotiated rate represents the maximum amount the insurance carrier is contractually allowed to pay, which serves as a ceiling to protect in-network members but does not guarantee the lowest possible price. This rate is notably higher than the Medicare benchmark of $456.40, suggesting a markup that exceeds the typical fair pricing range of 120% to 150% of Medicare. If you receive a bill for this service, you should request a full itemized CPT-coded statement rather than accepting a summary bill, as over 80% of hospital bills contain errors such as double-billing or unbund