CMS Price Transparency Data

Psychiatric evaluation (first visit)

Facility: North Shore Medical Center

Billing Code: 90791 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 90791
  • Insurance Median: $165
  • Cash Discount Price: $392
  • vs. Medicare Baseline: 0.91x Medicare
The contracted insurance negotiated median rate for a Psychiatric evaluation (first visit) at North Shore Medical Center is $165. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $392. Compared to the federal Medicare reimbursement reference rate of $181.34, this hospital’s rate is 0.91x the Medicare baseline. Located in 1100 Nw 95Th St, Miami, FL.
Cash / Self-Pay
$392

Average discount available for prompt cash payment at this facility.

Insurance Median
$165

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: $392 (216%)
Insurance Median: $165 (91%)
Cash: $392 (216% of Medicare)
Ins. Median: $165 (91% 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.

Out-of-Pocket Cost Estimator

Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash 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
Oscar Health Plan Hix $24 13%
Imagine Health $39 22%
Bc/Bs Of Fl Network Blue $56 31%
Bc/Bs Myblue Hmo Hix $60 33%
Bc/Bs Of Fl Blue Select Exchange Non Par $60 33%
Bc/Bs Of Fl Health Options Hmo $60 33%
Bc/Bs Of Fl Simplyblue $64 35%
Bc/Bs Of Fl Ppo $67 37%
Cigna $68 - $196 37%
Aetna $75 - $283 41%
Avmed Broad Network $82 45%
Medicaid / KanCare $98 - $392 54%
Veterans Administration Mill Bill $109 60%
Medicare (plans) $140 - $392 77%
Humana $147 - $157 81%
Leon Health Inc $155 85%
Devoted Health $156 86%
Tricare $156 86%
UnitedHealthcare $156 - $1,823 86%
Employer Direct Healthcare $158 - $216 87%
Hospice Other $158 87%
Veterans Administration Vaccn $158 87%
Healthsun Health Plans $163 - $179 90%
Longevity Health Plan $166 92%
Florida Pace Centers $187 103%
Bright Health Management Commercial $190 105%
Centurion Prison $194 107%
Self Pay/Uninsured $194 - $213 107%
Bc/Bs Of Fl Phs $203 112%
Magellan Behavioral Health $235 130%
Dimensions International $255 141%
First Health $267 147%
Avmed Exchange $277 153%
Ambetter / Centene $292 161%
Dimension Health Ppo $294 162%
Dimension Health Wc $294 162%
Workers Compensation $294 162%
Molina Marketplace Program Exchange $301 166%
Auto Insurance $316 174%
Avmed Select Network $323 178%
Amerihealth Caritas Next Exchange $340 187%
Beacon Health Strategies Commercial $392 216%
Commercial Non-Contracted $392 216%
Self Pay - Mcd Pending 100 Percent $392 216%
Single Case Agreement $392 216%
United Behavioral Health Psych $392 216%

Self-Pay Upfront Cash Action Plan

Insurance In-Network Protection Plan

Facility Profile & Credentials

  • Address: 1100 Nw 95Th St, Miami, FL 33150
  • CMS Rating: ★☆☆☆☆
  • Ownership Type: Proprietary
  • Hospital Type: Acute Care Hospitals