CMS Price Transparency Data

Psychological testing evaluation

Facility: UPMC Mercy

Billing Code: 96136 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 96136
Insurance Median: $143
Cash Discount Price: $226
vs. Medicare Baseline: 1.05x Medicare

The contracted insurance negotiated median rate for a Psychological testing evaluation at UPMC Mercy is $143. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $226. Compared to the federal Medicare reimbursement reference rate of $135.93, this hospital’s rate is 1.05x the Medicare baseline. Located in 1400 Locust Street, Pittsburgh, PA.

Cash / Self-Pay

$226

Average discount available for prompt cash payment at this facility.

Insurance Median

$143

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: $226 (166%)

Insurance Median: $143 (105%)

Cash: $226 (166% of Medicare)

Ins. Median: $143 (105% 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
Upmc Health Plan	$22 - $169	16%
UnitedHealthcare	$23	17%
Blue Cross Blue Shield	$28 - $160	21%
Highmark Wholecare (Prev Gateway)	$30 - $133	22%
Amerihealth Caritas	$32 - $133	24%
Pa Health & Wellness	$34 - $133	25%
Upmc Work Partners	$62	46%
Aetna	$105 - $150	77%
Cigna	$128 - $226	94%
Bravo	$132	97%
Coventry/First Health	$165	121%
Intergroup	$188 - $301	138%
Private Health Care Systems	$282	207%
American Healthcare Group	$301	221%
National Provider Network	$308	227%
Health Payors Organization	$338	249%
Multiplan	$338	249%

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 $226.
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 UPMC Mercy 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.