CMS Price Transparency Data

Psychological testing by technician

Facility: Boston Children's Hospital

Billing Code: 96138 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 96138
Insurance Median: $221
Cash Discount Price: $311
vs. Medicare Baseline: 0.48x Medicare

The contracted insurance negotiated median rate for a Psychological testing by technician at Boston Children's Hospital is $221. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $311. Compared to the federal Medicare reimbursement reference rate of $456.4, this hospital’s rate is 0.48x the Medicare baseline. Located in 300 Longwood Avenue, Boston, MA.

Cash / Self-Pay

$311

Average discount available for prompt cash payment at this facility.

Insurance Median

$221

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$456.4

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $456.4 (100%)

Cash / Self-Pay: $311 (68%)

Insurance Median: $221 (48%)

Cash: $311 (68% of Medicare)

Ins. Median: $221 (48% of 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.

Billing Status

Remaining Deductible ($)

Your Coinsurance Rate (%)

Input your details and click calculate to compare out-of-pocket costs.

Commercial Insurance Negotiated Rates

Negotiated contract ranges established by major commercial carriers at this facility.

Carrier / Plan Group	Contract Rate Range	vs. Medicare Reference
Blue Cross Blue Shield	$41 - $248	9%
Cdphp	$120 - $320	26%
Harvard Pilgrim	$125 - $254	27%
Aetna	$147 - $315	32%
United	$147 - $314	32%
Mgb/Allways	$149 - $278	33%
Tufts Public Plan	$150 - $232	33%
UnitedHealthcare	$151 - $320	33%
United Ri Nj Ny	$154 - $237	34%
Ambetter / Centene	$155 - $238	34%
Carelon Strategies/Bhs	$159 - $244	35%
Carelon/Beacon	$184 - $282	40%
Fallon	$187 - $290	41%
Health New England	$198 - $304	43%
Cigna	$208 - $348	46%
Ets/Lifetrac	$208 - $320	46%
Interlink Transplant	$208 - $320	46%
Community Health Options	$220 - $338	48%
Humana	$220 - $338	48%
Coventry/Hcvm/First Health	$225 - $346	49%
Multiplan/Phcs	$225 - $357	49%

Self-Pay Upfront Cash Action Plan

Request a "Self-Pay classification" with the billing desk before receiving care.
Ask for a written "Prompt-Pay Discount" agreement quoting the price of $311.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 96138.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Boston Children's Hospital is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 96138.
Confirm the specific physician or imaging center is also in-network (not just the hospital building).
Audit your Explanation of Benefits (EOB) against the final itemized hospital invoice.