CMS Price Transparency Data

Psychological testing evaluation

Facility: Prisma Health Richland Hospital

Billing Code: 96136 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 96136
Insurance Median: $165
Cash Discount Price: $155
vs. Medicare Baseline: 1.21x Medicare

The contracted insurance negotiated median rate for a Psychological testing evaluation at Prisma Health Richland Hospital is $165. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $155. Compared to the federal Medicare reimbursement reference rate of $135.93, this hospital’s rate is 1.21x the Medicare baseline. Located in 5 Medical Park, Columbia, SC.

Cash / Self-Pay

$155

Average discount available for prompt cash payment at this facility.

Insurance Median

$165

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: $155 (114%)

Insurance Median: $165 (121%)

Cash: $155 (114% of Medicare)

Ins. Median: $165 (121% 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
Medicaid / KanCare	$37 - $94	27%
UnitedHealthcare	$37 - $851	27%
Prisma Health Seniorcare Pace - Midlands [5400]	$55	40%
Prisma Health Seniorcare Pace-Upstate [5200]	$55	40%
Humana	$79 - $178	58%
Promise Health Plan Contracted [2401]	$83 - $143	61%
Orangeburg Senior Helping Center Pace [5401]	$95	70%
Blue Cross Blue Shield	$119 - $180	88%
Bluechoice [810]	$119 - $181	88%
Tricare	$121	89%
Bob Jones Univ-Pai [821]	$143	105%
Aetna	$152 - $188	112%
Meritain Health Contracted [2200]	$152 - $188	112%
Sc Dept Of Corrections [2998]	$161	118%
Scdc-Sc Dept Of Corrections [7232]	$161	118%
Cigna	$165	121%
Evernorth Behavioral Contracted [2982]	$165	121%
Preferred Administrators Contracted [2839]	$167	123%
Medcost [2940]	$176 - $198	129%
Atlantic Packaging Contracted [4833]	$178	131%
Planned Administrators [820]	$180	132%
Nippon [2300]	$188	138%
Aps Healthcare System [2981]	$190	140%
Multiplan/Phcs Contracted [2950]	$212	156%
Vsp Vision Care [2986]	$214	157%
First Health Contracted [2952]	$221	163%
Furman Int/Allen University Student [2951]	$221	163%
Quiktrip-First Health [3067]	$221	163%
Golden Rule Insurance Company [2991]	$851	626%
Oxford Health Plans [2992]	$851	626%
Zzumr-Salt Lake City Ut [3169]	$851	626%

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 $155.
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 Prisma Health Richland 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.