Psychological testing evaluation
Facility: Memorial Hospital
Billing Code: 96136 (CPT)
- CPT Billing Code: 96136
- Insurance Median: $66
- Cash Discount Price: $130
- vs. Medicare Baseline: 0.49x 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 |
|---|---|---|
| Tricare | $21 - $65 | 15% |
| Ambetter / Centene | $23 - $72 | 17% |
| Blue Cross Blue Shield | $41 | 30% |
| Humana | $65 | 48% |
| Medicare (plans) | $66 | 49% |
| Coventry - All Other Plans | $117 | 86% |
| Preferred Healthcare-All Plans | $124 | 91% |
| Health Partners Of Kansas - All Plans | $124 | 91% |
| Wppa/Providers Care-All Plans | $182 | 134% |
Consumer Guidance & Cost Commentary
For the CPT code 96136, Psychological testing evaluation, Memorial Hospital in Abilene, KS, lists a cash price of $130.00. This cash rate is identical to the facility's median negotiated rate of $130.00, which is significantly higher than the state average of $72.00. While commercial payers like Tricare and Ambetter / Centene negotiate rates ranging from $21 to $72, the facility's cash price remains at the maximum end of the spectrum. Patients with high-deductible plans may find paying the $130.00 cash price directly more cost-effective than using insurance, as the negotiated rates for many commercial plans exceed the cash amount. It is crucial to verify "self-pay" or "prompt-pay" discounts with the hospital before scheduling, as these upfront fee reductions can lower the final cost.
The facility's Medicare benchmarking data shows a gross charge of $130.00 against a Medicare amount of $135.93, resulting in a ratio of 0.5. This indicates the facility's billing is below the standard Medicare reimbursement rate, which often serves as a baseline for fair pricing. However, commercial negotiated rates vary widely across the nine payers listed, with rates for Coventry and Preferred Healthcare fixed at $117 and $124 respectively, while Wppa/Providers Care charges $182. To avoid unexpected costs, patients should request an itemized billing audit to ensure no unbundled codes or services not rendered are included in the final invoice. Additionally, under the No Surprises Act, patients are protected from balance billing for out