Psychological testing by technician
Facility: Children'S Mercy South
Billing Code: 96138 (CPT)
- CPT Billing Code: 96138
- Insurance Median: $64
- Cash Discount Price: $50
- vs. Medicare Baseline: 0.14x 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 |
|---|---|---|
| UnitedHealthcare | $32 - $69 | 7% |
| Medicaid / KanCare | $34 | 7% |
| Healthy Blue | $34 - $43 | 7% |
| Wppa Providrs Care | $38 | 8% |
| Home State Health | $43 | 9% |
| Healthlink | $44 | 10% |
| Health Midwest Comprehensive Care | $45 | 10% |
| American Healthcare Alliance | $47 | 10% |
| Medica | $61 | 13% |
| Wellfit/Centrus | $62 | 14% |
| Blue Cross Blue Shield | $64 | 14% |
| Centivo | $64 | 14% |
| Nebraska Furniture Mart | $69 | 15% |
| Mercy Health | $77 | 17% |
| Coxhealth Network | $78 | 17% |
| Cigna | $79 | 17% |
| National Preferred Provider Network | $92 | 20% |
Consumer Guidance & Cost Commentary
For the CPT code 96138, representing psychological testing by a technician, the gross charge at Children's Mercy South in Overland Park, KS, is $105.00. This facility is a voluntary non-profit private hospital. While the cash median price is $50.00, commercial insurance negotiated rates vary significantly by payer, ranging from a low of $32.00 with UnitedHealthcare to a high of $92.00 with the National Preferred Provider Network. It is important to note that cash-pay rates can sometimes be more affordable than insurance negotiated rates, particularly for patients with high-deductible plans where the insurer's allowed amount may exceed the cash price. Patients should verify their specific plan's negotiated rate before scheduling to ensure they are not paying more than necessary.
The Medicare benchmark for this service is $456.40, which serves as a critical baseline for evaluating pricing fairness. Commercial negotiated rates generally fall well below the Medicare amount, with the median negotiated rate across payers at $64.00. However, because the gross charge is significantly higher than the cash price, patients should inquire about "self-pay" or "prompt-pay" discounts before check-in, as these upfront payment incentives can further reduce the final cost. Additionally, if a patient receives care from an out-of-network provider, they may face balance billing for the difference between the provider's full charge and the insurance allowed amount, though the No Surprises Act offers protections against surprise bills for emergency and non-emergency services at in-network facilities.