Psychological testing by technician
Facility: Memorial Hospital
Billing Code: 96138 (CPT)
- CPT Billing Code: 96138
- Insurance Median: $36
- Cash Discount Price: $112
- vs. Medicare Baseline: 0.08x 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 |
|---|---|---|
| Tricare | $34 | 7% |
| Ambetter / Centene | $37 | 8% |
Consumer Guidance & Cost Commentary
For this psychological testing service at Memorial Hospital in Abilene, KS, the cash price of $112.00 is significantly lower than the facility's Medicare benchmark of $456.40, representing a 75% reduction. While the facility is a Critical Access Hospital owned by a government authority, the negotiated rates for in-network payers like Tricare and Ambetter/Centene average $36.00, which is lower than the cash price. This pricing structure suggests that for patients with high-deductible plans or those without insurance, paying the cash price directly may be more cost-effective than relying on insurance, as the insurer's allowed amount could exceed the cash rate. However, patients should verify their specific plan's deductible status and confirm whether the facility offers "self-pay" or "prompt-pay" discounts, as these upfront fee reductions can further lower the final cost.
It is important to understand that the $112.00 cash rate is not the same as the negotiated rate of $36.00, which reflects the contractual agreement between the hospital and insurance carriers. Although the data does not provide specific county or state average comparisons for this code, the significant gap between the cash price and the Medicare benchmark highlights how commercial rates can vary widely. If you are receiving care from an out-of-network provider or encounter unexpected charges, you may be subject to balance billing, where the provider bills you for the difference between their full chargemaster rate and what your insurance pays. To avoid surprise bills, always request an itemized bill before paying and dispute any charges that do not match the service rendered, ensuring you are not paying for unbundled codes or services that were never delivered