CMS Price Transparency Data

Psychological testing by technician

Facility: West Penn Hospital

Billing Code: 96138 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 96138
Insurance Median: $69
Cash Discount Price: $25
vs. Medicare Baseline: 0.15x Medicare

The contracted insurance negotiated median rate for a Psychological testing by technician at West Penn Hospital is $69. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $25. Compared to the federal Medicare reimbursement reference rate of $456.4, this hospital’s rate is 0.15x the Medicare baseline. Located in 4800 Friendship Avenue, Pittsburgh, PA.

Cash / Self-Pay

$25

Average discount available for prompt cash payment at this facility.

Insurance Median

$69

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: $25 (5%)

Insurance Median: $69 (15%)

Cash: $25 (5% of Medicare)

Ins. Median: $69 (15% 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
Highmark	$39 - $974	9%
Cigna	$52 - $1,274	11%
Community Care Behavorial Health Healthchoices	$60	13%
Community Care Behavorial Health University Of Pittsburgh Medical Center	$60	13%
UnitedHealthcare	$65 - $1,347	14%
American Health Plans	$384	84%
Life Pittsburgh	$384	84%
Martin'S Point	$384	84%
Medicare (plans)	$395	87%
Aetna	$399 - $1,271	87%
Amerihealth	$403	88%
Highmark Wholecare	$407	89%
Humana	$407	89%
Molina	$418	92%
Medical Mutual	$1,274	279%

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 $25.
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 West Penn 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.