CMS Price Transparency Data

Psychiatric evaluation (first visit)

Facility: Goshen Hospital

Billing Code: 90791 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 90791
Insurance Median: $155
Cash Discount Price: $382
vs. Medicare Baseline: 0.85x Medicare

The contracted insurance negotiated median rate for a Psychiatric evaluation (first visit) at Goshen Hospital is $155. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $382. Compared to the federal Medicare reimbursement reference rate of $181.34, this hospital’s rate is 0.85x the Medicare baseline. Located in 200 High Park Ave, Goshen, IN.

Cash / Self-Pay

$382

Average discount available for prompt cash payment at this facility.

Insurance Median

$155

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: $382 (211%)

Insurance Median: $155 (85%)

Cash: $382 (211% of Medicare)

Ins. Median: $155 (85% 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.

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
Advantage Health Solutions	$155	85%
Aetna	$155	85%
Atrio Health Plans	$155	85%
Bc Federal Employee	$155	85%
Bc Mcr Advantage Ppo	$155	85%
Blue Cross Blue Shield	$155 - $525	85%
Buckeye Health Plan	$155	85%
Cigna	$155	85%
Coventry Health And Life	$155	85%
Emblem Health	$155	85%
Freedom Healthcare	$155	85%
Geisinger Health Plan	$155	85%
Health First	$155	85%
Healthspring	$155	85%
Humana	$155	85%
Iehp Empire Health Plan	$155	85%
Independent Care Health Plan	$155	85%
Kaiser Permanente	$155	85%
Mcr Advantra Freedom	$155	85%
Mcr Allwell Mhs	$155	85%
Mcr Banner Health	$155	85%
Mcr Complete	$155	85%
Mcr Complete Ppo	$155	85%
Mcr Complete Wellmed	$155	85%
Mcr Health Alliance	$155	85%
Mcr Health Partners Plans	$155	85%
Mcr Medical Mutual Of Ohio	$155	85%
Mcr Passport Advantage	$155	85%
Mcr Secure Horizons Ppo	$155	85%
Mcr Texan Plus	$155	85%
Mcr Upmc For Life	$155	85%
Medicare (plans)	$155 - $164	85%
Meridian Complete	$155	85%
Optimum Healthcare	$155	85%
Paramount Elite	$155	85%
Primetime Health Plan	$155	85%
Simply Complete Hmo	$155	85%
The Umwa H&R Funds	$155	85%
Todays Options Pyramid Life	$155	85%
Trillium Advantage	$155	85%
Ucare For Seniors	$155	85%
Ucare Minnesota	$155	85%
UnitedHealthcare	$155	85%
Wellcare	$155	85%
Champva	$159	88%
Tricare	$159	88%
Mcr Devoted Health Plan	$164	90%
Mcr Provider Partners Hlth Pln	$175	97%
Ambetter / Centene	$223	123%
Mkt Caresource	$223	123%
Bc Allied	$525	290%

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 $382.
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 Goshen 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.