CMS Price Transparency Data

Psychiatric evaluation (first visit)

Facility: Fairview Hospital

Billing Code: 90791 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 90791
Insurance Median: $248
Cash Discount Price: $363
vs. Medicare Baseline: 1.37x Medicare

The contracted insurance negotiated median rate for a Psychiatric evaluation (first visit) at Fairview Hospital is $248. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $363. Compared to the federal Medicare reimbursement reference rate of $181.34, this hospital’s rate is 1.37x the Medicare baseline. Located in 29 Lewis Avenue, Great Barrington, MA.

Cash / Self-Pay

$363

Average discount available for prompt cash payment at this facility.

Insurance Median

$248

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: $363 (200%)

Insurance Median: $248 (137%)

Cash: $363 (200% of Medicare)

Ins. Median: $248 (137% 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
Other Government	$144 - $178	79%
Fallon	$149 - $187	82%
Commcare Alliance	$153 - $210	84%
Blue Cross Blue Shield	$154 - $325	85%
Medicare (plans)	$154 - $175	85%
Hospice	$156 - $178	86%
Health New England	$158 - $341	87%
UnitedHealthcare	$178 - $329	98%
Aetna	$197 - $289	109%
Point32Health	$216 - $363	119%
Comm Fallon Qhp	$218 - $236	120%
Workers Comp	$244	135%
Allways Nhp	$247	136%
Unicare	$248 - $260	137%
Comm Hne Hmo	$264 - $321	146%
Comm Hne Ppo	$280 - $341	154%
Capital District Physicians' Health Plan	$344	190%
Cigna	$344 - $356	190%
Mvp	$344	190%
Oxford	$344	190%
First Health	$356 - $363	196%
Connecticare	$363	200%
Consolidated Health Plans	$363	200%
Other Commercial	$363	200%
Phcs	$363	200%
Self Pay	$363	200%

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 $363.
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 Fairview 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.