CMS Price Transparency Data

Psychological testing evaluation

Facility: Essentia Health St Mary's Medical Center

Billing Code: 96136 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 96136
Insurance Median: $88
Cash Discount Price: $68
vs. Medicare Baseline: 0.65x Medicare

The contracted insurance negotiated median rate for a Psychological testing evaluation at Essentia Health St Mary's Medical Center is $88. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $68. Compared to the federal Medicare reimbursement reference rate of $135.93, this hospital’s rate is 0.65x the Medicare baseline. Located in 402 East Second Street, Duluth, MN.

Cash / Self-Pay

$68

Average discount available for prompt cash payment at this facility.

Insurance Median

$88

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$135.93

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $135.93 (100%)

Cash / Self-Pay: $68 (50%)

Insurance Median: $88 (65%)

Cash: $68 (50% of Medicare)

Ins. Median: $88 (65% of 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.

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
Medica Access	$34	25%
Healthpartners Care Pmap	$41	30%
Sanford Health Plan	$44 - $228	32%
Blue Cross Blue Shield	$45 - $295	33%
Blue Plus Pmap Pcc Prime	$45	33%
Medica	$57 - $58	42%
Medica Uplan	$57	42%
Healthpartners	$62 - $74	46%
Medica Choice	$63	46%
Ucare	$68	50%
Cigna	$74	54%
Healthpartners Pcc Prime	$74	54%
Wea	$74 - $79	54%
UnitedHealthcare	$75 - $129	55%
Security Health	$79	58%
America'S Ppo	$80	59%
Wps	$87	64%
Aetna	$88	65%
Healthscope Benefits	$88	65%
Healtheos	$89	65%
Primewest	$123	90%
Advocare/Security Health	$129	95%
Freedom Blue Ppo	$129	95%
Healthpartners Care Msho / Mcr Adv	$129	95%
Imcare Msho (Ref Req)	$129	95%
Imcare Msho Pcc Prime	$129	95%
Imcare Msho Ref Req	$129	95%
Itasca Med Care	$129	95%
Medica Advantage Solutions	$129	95%
Medica Msho/Dual Solutions	$129	95%
Medica Prime Solution Group	$129	95%
Medicare (plans)	$129	95%
Nd Va Administration	$129	95%
Platinum Blue / Vantage Blue	$129	95%
Primewest Msho	$129	95%
Secure Blue Msho	$129	95%
Ubh Cost Plan	$129	95%
Ubh Msho	$129	95%
Ucare Msho	$129	95%

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 $68.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 96136.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Essentia Health St Mary's Medical Center is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 96136.
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.