CMS Price Transparency Data

Psychiatric evaluation (first visit)

Facility: UMass Memorial Healthalliance Hospitals

Billing Code: 90791 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 90791
Insurance Median: $518
Cash Discount Price: $986
vs. Medicare Baseline: 2.86x Medicare

The contracted insurance negotiated median rate for a Psychiatric evaluation (first visit) at UMass Memorial Healthalliance Hospitals is $518. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $986. Compared to the federal Medicare reimbursement reference rate of $181.34, this hospital’s rate is 2.86x the Medicare baseline. Located in 60 Hospital Road, Leominster, MA.

Cash / Self-Pay

$986

Average discount available for prompt cash payment at this facility.

Insurance Median

$518

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: $986 (544%)

Insurance Median: $518 (286%)

Cash: $986 (544% of Medicare)

Ins. Median: $518 (286% 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 286% of the Medicare baseline (a markup of 186%). 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
Tufts [11201]	$28	15%
Cigna	$30 - $934	17%
Blue Cross Blue Shield	$32 - $236	18%
Medicaid / KanCare	$133 - $513	73%
Champva [11001]	$140	77%
Hsno/Free Care [10801]	$294	162%
Workers Compensation [20501]	$324	179%
UnitedHealthcare	$334 - $986	184%
Harvard Pilgrim [10701]	$493	272%
Institution [10406]	$523	288%
Hne [11108]	$550	303%
Aetna	$645	356%
Wellpoint [11112]	$726	400%
First Health Network [11120]	$740	408%
Multiplan [11109]	$740	408%
Fallon Connectorcare [10503]	$892	492%
Connecticare [11105]	$986	544%
Fallon Carelon Hlth [28]	$986	544%
Fallon Mcaid Carelon Hlth [29]	$986	544%
Grants [20507]	$986	544%

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 $986.
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 UMass Memorial Healthalliance Hospitals 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.