CMS Price Transparency Data

Review of medical records for care

Facility: Mt Sinai Hospital Medical Center

Billing Code: 90889 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 90889
Insurance Median: $148
Cash Discount Price: $126
vs. Medicare Baseline: N/A Medicare

The contracted insurance negotiated median rate for a Review of medical records for care at Mt Sinai Hospital Medical Center is $148. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $126. Compared to the federal Medicare reimbursement reference rate of N/A, this hospital’s rate is N/A the Medicare baseline. Located in 15Th Street at California, Chicago, IL.

Cash / Self-Pay

$126

Average discount available for prompt cash payment at this facility.

Insurance Median

$148

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

N/A

Standard federal government reimbursement rate for this code.

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
Partners In Hlth - All Plans	$72	N/A
Blue Cross Blue Shield	$80 - $152	N/A
Compsych Ip/Op Only - All Plans	$108	N/A
Healthlink Hmo	$117	N/A
Hfn Platinum	$117	N/A
Healthlink Ppo - All Other Plans	$126	N/A
Multiplan Primary Ntwrk/Phcs - All Other Plans	$126	N/A
Hfn Epo	$144	N/A
Multiplan Complementary Ntwrk	$144	N/A
Aetna	$152 - $407	N/A
Family Health Network Mcaid - All Plans	$152	N/A
Hfn Ppo - All Other Plans	$158	N/A
Cigna	$160 - $223	N/A
Molina Mcaid	$160	N/A
Ambetter / Centene	$189	N/A
Oscar - All Plans	$198	N/A
Humana	$565	N/A

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 $126.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 90889.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Mt Sinai Hospital Medical Center is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 90889.
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.