CMS Price Transparency Data

Psychiatric evaluation (first visit)

Facility: Mary Hitchcock Memorial Hospital

Billing Code: 90791 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 90791
Insurance Median: $340
Cash Discount Price: $178
vs. Medicare Baseline: 1.87x Medicare

The contracted insurance negotiated median rate for a Psychiatric evaluation (first visit) at Mary Hitchcock Memorial Hospital is $340. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $178. Compared to the federal Medicare reimbursement reference rate of $181.34, this hospital’s rate is 1.87x the Medicare baseline. Located in 1 Medical Center Drive, Lebanon, NH.

Cash / Self-Pay

$178

Average discount available for prompt cash payment at this facility.

Insurance Median

$340

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: $178 (98%)

Insurance Median: $340 (187%)

Cash: $178 (98% of Medicare)

Ins. Median: $340 (187% 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
Amerihealth Caritas Nh	$64 - $181	35%
Beacon Health Strategies/Carelon	$64 - $176	35%
Granite State Health Plan	$64 - $187	35%
Wellsense Health Plan	$64 - $189	35%
Harvard Pilgrim Health Care Of Ne	$106 - $680	58%
Aetna	$118 - $408	65%
Blue Cross Blue Shield	$143 - $700	79%
Martin'S Point Generations Advantage	$143 - $180	79%
Mvp	$143 - $400	79%
UnitedHealthcare	$143 - $586	79%
Cigna	$147 - $662	81%
Martin'S Point Health Care	$148 - $200	82%
Wellcare Health Plans	$149 - $187	82%
Ambetter / Centene	$150 - $552	83%
Mass General Brigham Health Plan	$325 - $376	179%
Tufts Health Plan	$327 - $685	180%
Maine Community Health Options	$370 - $427	204%
Coventry	$505	278%
First Health/Hcvm	$505	278%
Phcs	$523	288%
Corvel	$535	295%
Ccmsi	$552	304%

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 $178.
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 Mary Hitchcock Memorial 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.