CMS Price Transparency Data

Psychological testing by technician

Facility: UPMC Presbyterian Shadyside

Billing Code: 96138 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 96138
Insurance Median: $965
Cash Discount Price: $857
vs. Medicare Baseline: 2.11x Medicare

The contracted insurance negotiated median rate for a Psychological testing by technician at UPMC Presbyterian Shadyside is $965. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $857. Compared to the federal Medicare reimbursement reference rate of $456.4, this hospital’s rate is 2.11x the Medicare baseline. Located in 200 Lothrop Street, Pittsburgh, PA.

Cash / Self-Pay

$857

Average discount available for prompt cash payment at this facility.

Insurance Median

$965

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: $857 (188%)

Insurance Median: $965 (211%)

Cash: $857 (188% of Medicare)

Ins. Median: $965 (211% 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.

Elevated Commercial Rate Alert (Value-Gap)

The negotiated rate at this facility is 211% of the Medicare baseline (a markup of 111%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Consult Patient Advocate

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	$22 - $149	5%
Upmc Work Partners	$51	11%
Multiplan	$59 - $1,143	13%
Aetna	$257 - $418	56%
UnitedHealthcare	$276 - $411	60%
Amerihealth Caritas	$411	90%
Cigna	$411	90%
Highmark Wholecare (Prev Gateway)	$411	90%
Pa Health & Wellness	$411	90%
Upmc Health Plan	$670	147%
Geisinger	$786	172%
Preferred Healthcare System	$929	204%
Coventry/First Health	$1,000	219%
Fidelis	$1,072	235%
Intergroup	$1,072 - $1,215	235%
Health Coalition Partners	$1,143	250%
Private Health Care Systems	$1,143	250%
Selectcare	$1,143	250%
Health Payors Organization	$1,215	266%
Humana	$1,215	266%

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 $857.
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 UPMC Presbyterian Shadyside 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.