CMS Price Transparency Data

Psychiatric evaluation (first visit)

Facility: Good Samaritan Medical Center

Billing Code: 90791 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 90791
Insurance Median: $217
Cash Discount Price: $147
vs. Medicare Baseline: 1.20x Medicare

The contracted insurance negotiated median rate for a Psychiatric evaluation (first visit) at Good Samaritan Medical Center is $217. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $147. Compared to the federal Medicare reimbursement reference rate of $181.34, this hospital’s rate is 1.20x the Medicare baseline. Located in 235 North Pearl Street, Brockton, MA.

Cash / Self-Pay

$147

Average discount available for prompt cash payment at this facility.

Insurance Median

$217

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: $147 (81%)

Insurance Median: $217 (120%)

Cash: $147 (81% of Medicare)

Ins. Median: $217 (120% 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
Cigna	$39 - $196	22%
Tufts [8002]	$39	22%
Harvard Pilgrim Health Care [8001]	$170	94%
Mass General Brigham Health Plan Commercial [8009]	$189	104%
Mass General Brigham Health Plan Prime [7003]	$189	104%
Aetna	$212	117%
Meritain Health [1023]	$212	117%
Blue Cross Blue Shield	$223 - $259	123%
Unicare [8004]	$245	135%
Wellpoint [2034]	$245	135%
Hsn Bad Debt [4003]	$395	218%
Hsn Confidential [4007]	$395	218%
Hsn Dental [4006]	$395	218%
Hsn Partial [4002]	$395	218%
Hsn [4001]	$395	218%

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 $147.
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 Good Samaritan Medical Center 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.