Psychological testing evaluation
Facility: Kansas City Orthopaedic Institute
Billing Code: 96136 (CPT)
- CPT Billing Code: 96136
- Insurance Median: $295
- Cash Discount Price: Unavailable
- vs. Medicare Baseline: 2.17x 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.
Elevated Commercial Rate Alert (Value-Gap)
The negotiated rate at this facility is 217% of the Medicare baseline (a markup of 117%). 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 | $113 | 83% |
| Aetna | $113 | 83% |
| Cigna | $121 | 89% |
| Blue Cross Blue Shield | $295 | 217% |
Consumer Guidance & Cost Commentary
For the CPT code 96136, "Psychological testing evaluation," at Kansas City Orthopaedic Institute in Leawood, KS, the negotiated rates vary significantly by insurer, ranging from $113 with UnitedHealthcare and Aetna to $295 with Blue Cross Blue Shield. While the facility is a physician-owned acute care hospital, the data indicates no specific cash or median paid rates were reported for this service. It is important to note that cash-pay options can sometimes be more cost-effective for patients with high-deductible plans if the insurance negotiated rate exceeds the cash price, though current data does not reflect a cash rate for this specific code. Patients should always verify "self-pay" or "prompt-pay" discounts directly with the hospital before scheduling, as these upfront payment incentives can bypass the administrative costs and higher negotiated rates associated with insurance billing.
When evaluating the cost of this service, it is crucial to compare rates against the Medicare benchmark rather than the facility's inflated chargemaster list. The Medicare amount for this procedure is $135.93, and the facility's negotiated rate of $295.00 represents a markup of 2.2 times the Medicare rate. This aligns with the typical commercial pricing structure where negotiated rates often average 200% to 300% of Medicare, whereas fair pricing is generally defined as 120% to 150% of the Medicare amount. Consumers should be aware that hospitals often issue summary bills that obscure individual line items; requesting a full itemized CPT-coded bill is the most effective way to identify errors, unbundled codes, or services not rendered, ensuring you are only