CMS Price Transparency Data

Psychiatric evaluation (first visit)

Facility: UMass Memorial Health - Harrington Hospital

Billing Code: 90791 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 90791
Insurance Median: $302
Cash Discount Price: $860
vs. Medicare Baseline: 1.67x Medicare

The contracted insurance negotiated median rate for a Psychiatric evaluation (first visit) at UMass Memorial Health - Harrington Hospital is $302. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $860. Compared to the federal Medicare reimbursement reference rate of $181.34, this hospital’s rate is 1.67x the Medicare baseline. Located in 100 South Street, Southbridge, MA.

Cash / Self-Pay

$860

Average discount available for prompt cash payment at this facility.

Insurance Median

$302

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: $860 (474%)

Insurance Median: $302 (167%)

Cash: $860 (474% of Medicare)

Ins. Median: $302 (167% 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
Blue Cross Blue Shield	$29 - $230	16%
Champva [11001]	$145	80%
Workers Compensation [20501]	$147 - $692	81%
Medicaid / KanCare	$157 - $737	87%
Hne [11108]	$197 - $923	109%
Cigna	$215 - $1,103	119%
Tufts [11201]	$215 - $1,008	119%
Wellpoint [11112]	$222 - $1,044	122%
First Health Network [11120]	$226 - $1,064	125%
Evernorth Behavioral Health [27]	$242 - $1,134	133%
Aetna	$243 - $1,418	134%
Harvard Pilgrim [10701]	$248 - $1,163	137%
UnitedHealthcare	$256 - $1,418	141%
Connecticare [11105]	$302 - $1,418	167%
Fallon Carelon Hlth [28]	$302 - $1,418	167%
Fallon Mcaid Carelon Hlth [29]	$302 - $1,418	167%
Grants [20507]	$302 - $1,418	167%
Masshealth Mcd Mbhp [38]	$302 - $1,418	167%
Wellsense Mcaid Carelon Hlth [21]	$302 - $1,418	167%
Hsno/Free Care [10801]	$681	376%
Fallon Connectorcare [10503]	$892	492%

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 $860.
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 Health - Harrington 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.