CMS Price Transparency Data

Psychological testing evaluation

Facility: Nationwide Children's Hospital

Billing Code: 96136 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 96136
Insurance Median: $178
Cash Discount Price: $199
vs. Medicare Baseline: 1.31x Medicare

The contracted insurance negotiated median rate for a Psychological testing evaluation at Nationwide Children's Hospital is $178. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $199. Compared to the federal Medicare reimbursement reference rate of $135.93, this hospital’s rate is 1.31x the Medicare baseline. Located in 700 Children's Drive, Columbus, OH.

Cash / Self-Pay

$199

Average discount available for prompt cash payment at this facility.

Insurance Median

$178

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: $199 (146%)

Insurance Median: $178 (131%)

Cash: $199 (146% of Medicare)

Ins. Median: $178 (131% 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
Amerihealth	$34 - $278	25%
Bchp	$34 - $278	25%
Blue Cross Blue Shield	$34 - $278	25%
Caresource	$34 - $278	25%
Humana	$34 - $278	25%
Molina	$34 - $278	25%
UnitedHealthcare	$34 - $278	25%
Tricare	$37	27%
Aetna	$47 - $247	35%
Ohio Ppo Connect	$116 - $242	85%
Osu	$116 - $242	85%
Ohg	$164 - $234	121%
Ohc	$169 - $242	124%
Ahpo	$171 - $244	126%
Cigna	$171 - $244	126%
Front Path Health Coalition	$171 - $244	126%
Mmo	$171 - $244	126%
Unicare	$173 - $247	127%
The Health Plan	$175 - $250	129%
Emerald Health	$178 - $255	131%
First Health	$178 - $255	131%
Phcs	$178 - $255	131%

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 $199.
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 Nationwide Children's Hospital 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.