CMS Price Transparency Data

Psychological testing by technician

Facility: Cleveland Clinic Avon Hospital

Billing Code: 96138 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 96138
Insurance Median: $399
Cash Discount Price: $534
vs. Medicare Baseline: 0.87x Medicare

The contracted insurance negotiated median rate for a Psychological testing by technician at Cleveland Clinic Avon Hospital is $399. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $534. Compared to the federal Medicare reimbursement reference rate of $456.4, this hospital’s rate is 0.87x the Medicare baseline. Located in 33300 Cleveland Clinic Blvd, Avon, OH.

Cash / Self-Pay

$534

Average discount available for prompt cash payment at this facility.

Insurance Median

$399

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: $534 (117%)

Insurance Median: $399 (87%)

Cash: $534 (117% of Medicare)

Ins. Median: $399 (87% 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	$153 - $656	34%
Buckeye	$153	34%
Molina	$153	34%
Caresource	$156	34%
United	$156 - $502	34%
Oscar	$247 - $316	54%
Summacare	$302 - $370	66%
Cc Ehp	$328 - $333	72%
Aultcare	$353	77%
Amish Community Aid Plan	$369 - $410	81%
Aetna	$370 - $821	81%
Devoted Health	$370	81%
Humana	$370	81%
Mmo	$370 - $441	81%
The Health Plan	$370 - $493	81%
UnitedHealthcare	$370 - $509	81%
Upmc	$370 - $493	81%
Valor	$370	81%
Cigna	$381 - $428	83%
Communicare	$388	85%
Ohcp	$399	87%
Perennial Health	$400	88%
Pphp	$407	89%
Zing Health	$407	89%
Omas	$410	90%
Ohio Healthy	$443	97%
Php	$493	108%
Gms	$575	126%
Medical Benefit Corp	$575	126%
Consociate Health	$616	135%
Frontpath	$739	162%
Managed Care Services	$739	162%
Multiplan	$739	162%
Tertiary Care Network	$739	162%

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 $534.
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 Cleveland Clinic Avon 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.