CMS Price Transparency Data

Psychological testing by technician

Facility: Nationwide Children's Hospital Toledo, LLC

Billing Code: 96138 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 96138
Insurance Median: $308
Cash Discount Price: $569
vs. Medicare Baseline: 0.67x Medicare

The contracted insurance negotiated median rate for a Psychological testing by technician at Nationwide Children's Hospital Toledo, LLC is $308. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $569. Compared to the federal Medicare reimbursement reference rate of $456.4, this hospital’s rate is 0.67x the Medicare baseline. Located in 2213 Cherry Street, Toledo, OH.

Cash / Self-Pay

$569

Average discount available for prompt cash payment at this facility.

Insurance Median

$308

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: $569 (125%)

Insurance Median: $308 (67%)

Cash: $569 (125% of Medicare)

Ins. Median: $308 (67% 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
UnitedHealthcare	$25 - $479	5%
Tricare	$29	6%
Caresource	$34 - $479	7%
Paramount	$34	7%
Blue Cross Blue Shield	$36 - $484	8%
Front Path Health Coalition	$45 - $427	10%
Ohc	$46 - $474	10%
Ohio Ppo Connect	$46 - $474	10%
Mcclaren Health Plan	$48 - $427	11%
Mmo	$62 - $332	14%
Cigna	$107	23%
Molina	$205 - $479	45%
Amerihealth	$207	45%
Bchp	$207	45%
Humana	$207	45%
Aetna	$365	80%
Mcclaren Health Plan - Michigan	$470	103%
First Health	$731	160%

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 $569.
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 Nationwide Children's Hospital Toledo, LLC 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.