CMS Price Transparency Data

Psychological testing evaluation

Facility: UPMC Presbyterian Shadyside

Billing Code: 96136 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 96136
Insurance Median: $339
Cash Discount Price: $434
vs. Medicare Baseline: 2.49x Medicare

The contracted insurance negotiated median rate for a Psychological testing evaluation at UPMC Presbyterian Shadyside is $339. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $434. Compared to the federal Medicare reimbursement reference rate of $135.93, this hospital’s rate is 2.49x the Medicare baseline. Located in 200 Lothrop Street, Pittsburgh, PA.

Cash / Self-Pay

$434

Average discount available for prompt cash payment at this facility.

Insurance Median

$339

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: $434 (319%)

Insurance Median: $339 (249%)

Cash: $434 (319% of Medicare)

Ins. Median: $339 (249% 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.

Elevated Commercial Rate Alert (Value-Gap)

The negotiated rate at this facility is 249% of the Medicare baseline (a markup of 149%). 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
Upmc Health Plan	$22 - $339	16%
UnitedHealthcare	$24 - $133	18%
Aetna	$26 - $181	19%
Blue Cross Blue Shield	$28 - $189	21%
Health Partners Plans (Jefferson Health Plan)	$30	22%
Highmark Wholecare (Prev Gateway)	$30 - $362	22%
Geisinger	$31	23%
Amerihealth Caritas	$32 - $133	24%
Pa Health & Wellness	$34 - $133	25%
Upmc Work Partners	$62	46%
Multiplan	$72 - $578	53%
Cigna	$133	98%
Preferred Healthcare System	$470	346%
Coventry/First Health	$506	372%
Fidelis	$542	399%
Intergroup	$542 - $615	399%
Health Coalition Partners	$578	425%
Private Health Care Systems	$578	425%
Selectcare	$578	425%
Health Payors Organization	$615	452%
Humana	$615	452%

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 $434.
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 Presbyterian Shadyside 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.