What this guide is best for
Direct answer: Use this when the same testing is available in both settings and you are deciding which to book.
Best used when: The professional fee is similar in both. The hospital adds a separate facility charge that no public dataset shows.
Hospital or private practice
Key point: The professional fee is similar in both. The hospital adds a separate facility charge that no public dataset shows.
What a good provider should make clear: Both settings asked for a total estimate including any facility fee, in writing, before booking.
Common mistake: Comparing the clinician bill only, and being surprised by the hospital charge that arrives separately.
Questions to ask: Will there be a separate facility or hospital charge, and how much is it?
Hospital or private practice
Opening intent: answer the hospital-or-private question with the published figures for both settings
| Decision factor | What to compare |
|---|---|
| Best use case | Use this when the same testing is available in both settings and you are deciding which to book. |
| Main tradeoff | The professional fee is similar in both. The hospital adds a separate facility charge that no public dataset shows. |
| Common mistake | Comparing the clinician bill only, and being surprised by the hospital charge that arrives separately. |
| Question to ask | Will there be a separate facility or hospital charge, and how much is it? |
Quick answer
For the clinician's own bill, the two settings are close. The difference that matters is the hospital's separate facility charge, and it is not in any public price file.
Ask the hospital directly whether a facility fee applies. That single question changes the comparison more than anything else on this page.
What each setting bills for the professional work
National Medicare figures for calendar year 2024. "Office" is private practice; "hospital outpatient" is the facility setting.
| Code | What it covers | Office: billed / allowed | Hospital outpatient: billed / allowed |
|---|---|---|---|
| 96116 | Neurobehavioral status exam, first hour | $252.62 / $90.56 | $291.79 / $78.24 |
| 96130 | Psychological testing evaluation, first hour | $288.14 / $114.01 | $270.44 / $105.25 |
| 96132 | Neuropsychological testing evaluation, first hour | $317.32 / $124.09 | $342.05 / $102.52 |
| 96133 | Neuropsychological testing evaluation, each extra hour | $278.83 / $95.38 | $300.95 / $75.03 |
| 96136 | Test administration, first 30 minutes | $128.16 / $39.87 | $100.28 / $22.93 |
| 96137 | Test administration, each extra 30 minutes | $125.20 / $36.83 | $99.73 / $17.69 |
Note what happens to the allowed column. For test administration, Medicare allowed $39.87 in the office against $22.93 in the hospital setting.
That looks like the hospital is cheaper. It is not. Medicare pays the clinician less in a facility because it pays the facility separately, on a different claim.
The number this page cannot give you
The hospital's own facility charge is billed on a separate claim that does not appear in this dataset. We will not estimate it.
What we can say is its direction: it is additional, and it is the reason hospital-based testing commonly costs the patient more overall.
Get it in writing from the hospital's billing office before you book. Ask for the estimate to name both the professional and the facility component.
Non-cost reasons the setting matters
Hospital programmes often have access to imaging, neurology and medical records in the same system. That is worth something when the referral question is medical.
Private practices are often faster to schedule and easier to reach afterwards. That is worth something when the question is educational or occupational.
Wait times, not price, are frequently the deciding factor. Ask both for a realistic date.
Questions to ask both settings
- Will I receive more than one bill for this evaluation?
- Is there a facility fee, and what is it?
- How many testing hours are planned?
- How long until the report is delivered?
- Who explains the results, and is that visit included?
Common mistake: comparing the two settings on the clinician's quote alone.
Where these numbers come from, and what they are not
Source: Centers for Medicare & Medicaid Services, Medicare Physician & Other Practitioners — by Geography and Service, calendar year 2024 claims (file released 21 May 2026).
Method: we pull the published rows for each billing code, keep the average submitted charge and the average Medicare allowed amount, and print them unchanged. Nothing is modelled, averaged across codes, or adjusted.
- The submitted charge is what clinicians billed. It is list price. Almost nobody pays it.
- The allowed amount is what Medicare permitted, including the patient's coinsurance. It is a negotiated price.
- These are Medicare fee-for-service claims. The patients skew 65 and older.
- If you are paying cash or using commercial insurance, neither figure is your price. Use the gap between them as a bargaining range, not a quote.
- CMS hides any cell covering fewer than 11 patients, so some states are missing. We print "not published" there rather than guessing.
Common mistake: reading the allowed amount as "the real price" and expecting a clinic to match it. It is what one payer pays one set of clinicians.
What to do next
Ask each setting for a single all-in written estimate. If a hospital cannot give you one, treat the gap as a cost.
Educational only. Not medical advice. No endorsements or rankings.