Psychological testing by technician
Facility: Cloud County Health Center
Billing Code: 96138 (CPT)
- CPT Billing Code: 96138
- Insurance Median: $77
- Cash Discount Price: $79
- vs. Medicare Baseline: 0.17x 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 $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.
Commercial Insurance Negotiated Rates
Negotiated contract ranges established by major commercial carriers at this facility.
| Carrier / Plan Group | Contract Rate Range | vs. Medicare Reference |
|---|---|---|
| Mpi-All Plans | $48 | 11% |
| Pponext-All Plans | $107 | 23% |
Consumer Guidance & Cost Commentary
For the CPT code 96138, "Psychological testing by technician," Cloud County Health Center in Concordia, KS, lists a cash median price of $79.00, which is notably lower than the facility's negotiated rates of $107.00 and $77.00 for in-network payers Mpi-All Plans and Pponext-All Plans. This pricing structure highlights a common billing dynamic where cash-pay options can be more affordable than insurance-covered services, particularly for patients with high-deductible plans who may face higher out-of-pocket costs if their negotiated rates exceed the cash price. While the facility is a Critical Access Hospital with a voluntary non-profit ownership, patients should verify their specific plan details and ask directly about "self-pay" or "prompt-pay" discounts before scheduling, as these upfront incentives can further reduce the final amount owed.
It is important to distinguish between the facility's gross charge of $112.00 and the actual amounts paid or allowed, as the difference often stems from balance billing or administrative markups rather than the base cost of care. Although the data does not provide specific county or state average comparisons for this procedure, the significant gap between the cash rate and the Medicare benchmark of $456.40 suggests that the facility's pricing is well below the federal baseline, indicating a potentially fair rate relative to the true cost of delivery. Consumers should be aware that while the No Surprises Act protects against balance billing for out-of-network services at in-network facilities, it is still prudent to request an itemized bill to ensure no unbundled codes or services not rendered are included in the final invoice.