Psychological testing evaluation
Facility: Golden Valley Memorial Hospital
Billing Code: 96136 (CPT)
- CPT Billing Code: 96136
- Insurance Median: $129
- Cash Discount Price: $16
- vs. Medicare Baseline: 0.95x 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 |
|---|---|---|
| Home State Health | $114 | 84% |
| UnitedHealthcare | $114 - $220 | 84% |
| Aetna | $129 | 95% |
| Humana | $129 | 95% |
| Ambetter / Centene | $155 | 114% |
Consumer Guidance & Cost Commentary
For this psychological testing evaluation at Golden Valley Memorial Hospital in Clinton, MO, the service is priced significantly lower than the national benchmark, with a Medicare rate of $135.93. While the facility's gross charge is listed at $26, the actual cost to payers ranges from $114 to $220 depending on the insurance plan, with UnitedHealthcare members facing the highest potential cost of $220. The facility is a government-owned acute care hospital rated 3 stars, and while the cash median price is $16, patients should be aware that insurance negotiated rates often exceed cash prices; however, because the cash rate is so low here, paying out-of-pocket might result in a lower final bill than using insurance for those with high deductibles.
To avoid unexpected costs, patients should verify if the facility offers self-pay or prompt-pay discounts before scheduling, as these can provide immediate fee reductions by bypassing the administrative overhead of insurance claims. Although the No Surprises Act protects against balance billing for emergency care and non-emergency services from out-of-network providers at in-network facilities, it is crucial to request an itemized billing audit to ensure no unbundled codes or services not rendered are included in the final invoice. Given that over 80% of hospital bills contain errors, consumers should demand a detailed, line-by-line statement rather than accepting a summary bill, and always confirm their deductible status before allowing insurance to process the claim to prevent paying full negotiated rates without reimbursement.