CMS Price Transparency Data

Psychological testing by technician

Facility: Prisma Health Tuomey Hospital

Billing Code: 96138 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 96138
Insurance Median: $599
Cash Discount Price: $649
vs. Medicare Baseline: 1.31x Medicare

The contracted insurance negotiated median rate for a Psychological testing by technician at Prisma Health Tuomey Hospital is $599. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $649. Compared to the federal Medicare reimbursement reference rate of $456.4, this hospital’s rate is 1.31x the Medicare baseline. Located in 129 N Washington St, Sumter, SC.

Cash / Self-Pay

$649

Average discount available for prompt cash payment at this facility.

Insurance Median

$599

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: $649 (142%)

Insurance Median: $599 (131%)

Cash: $649 (142% of Medicare)

Ins. Median: $599 (131% 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	$20 - $711	4%
Bluechoice [810]	$20 - $712	4%
Medicaid / KanCare	$61 - $154	13%
Humana	$65 - $748	14%
UnitedHealthcare	$154 - $244	34%
Prisma Health Seniorcare Pace - Midlands [5400]	$232	51%
Prisma Health Seniorcare Pace-Upstate [5200]	$232	51%
Golden Rule Insurance Company [2991]	$244	53%
Oxford Health Plans [2992]	$244	53%
Zzumr-Salt Lake City Ut [3169]	$244	53%
Promise Health Plan Contracted [2401]	$349 - $599	76%
Scdc-Sc Dept Of Corrections [7232]	$388	85%
Orangeburg Senior Helping Center Pace [5401]	$399	87%
Bob Jones Univ-Pai [821]	$599	131%
Aetna	$639 - $788	140%
Meritain Health Contracted [2200]	$639 - $788	140%
Preferred Administrators Contracted [2839]	$699	153%
Planned Administrators [820]	$711	156%
Medcost [2940]	$739 - $828	162%
Atlantic Packaging Contracted [4833]	$748	164%
Cigna	$765	168%
Aps Healthcare System [2981]	$798	175%
Multiplan/Phcs Contracted [2950]	$888	195%
Vsp Vision Care [2986]	$898	197%
First Health Contracted [2952]	$928	203%
Furman Int/Allen University Student [2951]	$928	203%
Quiktrip-First Health [3067]	$928	203%

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 $649.
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 Prisma Health Tuomey 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.