CMS Price Transparency Data

Psychiatric evaluation (first visit)

Facility: Fairfield Medical Center

Billing Code: 90791 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 90791
Insurance Median: $382
Cash Discount Price: $248
vs. Medicare Baseline: 2.11x Medicare

The contracted insurance negotiated median rate for a Psychiatric evaluation (first visit) at Fairfield Medical Center is $382. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $248. Compared to the federal Medicare reimbursement reference rate of $181.34, this hospital’s rate is 2.11x the Medicare baseline. Located in 401 North Ewing Street, Lancaster, OH.

Cash / Self-Pay

$248

Average discount available for prompt cash payment at this facility.

Insurance Median

$382

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: $248 (137%)

Insurance Median: $382 (211%)

Cash: $248 (137% of Medicare)

Ins. Median: $382 (211% 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 211% of the Medicare baseline (a markup of 111%). 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
Humana	$154 - $5,975	85%
Aetna	$168 - $5,975	93%
Blue Cross Blue Shield	$168 - $26,250	93%
Buckeye Community Health	$168 - $9,449	93%
Medical Mutual	$168 - $33,500	93%
Medicare (plans)	$168 - $5,975	93%
Medigold	$171 - $6,096	94%
Molina	$171 - $10,059	94%
UnitedHealthcare	$171 - $6,096	94%
Va Ccn	$171 - $6,096	94%
The Health Plan	$172 - $6,095	95%
Valor Health Plan	$172 - $6,095	95%
Caresource	$175 - $7,925	97%
Medicaid / KanCare	$183	101%
Amerihealth Caritas Ohio	$192	106%
Bwc	$238 - $8,468	131%
Oscar	$317 - $6,242	175%
Allied Benefit Systems	$382	211%
Meritain Health	$382	211%
Quality Care Partners/Ohio Ppo Connect	$396	218%
The Ohio State Health Plan	$424	234%
Cigna	$453	250%
Ohio Healthy	$517	285%
Multiplan	$522	288%
Miscellaneous Plans	$550	303%

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 $248.
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 Fairfield 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.