CMS Price Transparency Data

Psychiatric evaluation (first visit)

Facility: Good Samaritan Hospital

Billing Code: 90791 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 90791
Insurance Median: $577
Cash Discount Price: $1,448
vs. Medicare Baseline: 3.18x Medicare

The contracted insurance negotiated median rate for a Psychiatric evaluation (first visit) at Good Samaritan Hospital is $577. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,448. Compared to the federal Medicare reimbursement reference rate of $181.34, this hospital’s rate is 3.18x the Medicare baseline. Located in 2425 Samaritan Drive, San Jose, CA.

Cash / Self-Pay

$1,448

Average discount available for prompt cash payment at this facility.

Insurance Median

$577

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$181.34

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $181.34 (100%)

Cash / Self-Pay: $1,448 (799%)

Insurance Median: $577 (318%)

Cash: $1,448 (799% of Medicare)

Ins. Median: $577 (318% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $181.34 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 318% of the Medicare baseline (a markup of 218%). 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
Physicians Medical Group	$128	71%
Blue Cross Blue Shield	$141	78%
Medcare Partners	$217	120%
Santa Clara Family Health Plan	$275	152%
Bright Health	$291	160%
Aetna	$301 - $307	166%
Cigna	$337 - $1,159	186%
Health Net	$338	186%
United	$369	203%
Blue Shield	$430	237%
Santa Clara Ipa Comm	$724	399%
Santa Clara Ipa Mcr	$724	399%
Nx Health Network	$869	479%
Sutter Select	$869	479%
Multiplan	$942 - $1,159	519%
Humana	$1,014	559%
First Health	$1,101 - $1,448	607%
Healthsmart	$1,159 - $1,231	639%
Intercontinental Corporation	$1,159	639%
Pha Pacific Health Alliance	$1,159	639%
Ppo Next	$1,159	639%

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 $1,448.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 90791.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Good Samaritan Hospital is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 90791.
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.