CMS Price Transparency Data

Psychiatric evaluation (first visit)

Facility: South Pointe Hospital

Billing Code: 90791 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 90791
Insurance Median: $173
Cash Discount Price: $214
vs. Medicare Baseline: 0.95x Medicare

The contracted insurance negotiated median rate for a Psychiatric evaluation (first visit) at South Pointe Hospital is $173. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $214. Compared to the federal Medicare reimbursement reference rate of $181.34, this hospital’s rate is 0.95x the Medicare baseline. Located in 20000 Harvard Road, Warrensville Heights, OH.

Cash / Self-Pay

$214

Average discount available for prompt cash payment at this facility.

Insurance Median

$173

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: $214 (118%)

Insurance Median: $173 (95%)

Cash: $214 (118% of Medicare)

Ins. Median: $173 (95% 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
Oscar	$99 - $126	55%
Summacare	$113 - $149	62%
Cc Ehp	$131 - $133	72%
United	$138 - $201	76%
Aultcare	$141	78%
Aetna	$149 - $329	82%
Blue Cross Blue Shield	$149 - $263	82%
Devoted Health	$149	82%
Humana	$149 - $280	82%
The Health Plan	$149 - $197	82%
UnitedHealthcare	$149 - $204	82%
Upmc	$149 - $197	82%
Valor	$149	82%
Cigna	$153 - $227	84%
Communicare	$156	86%
Ohcp	$160	88%
Perennial Health	$161	89%
Omas	$164	90%
Pphp	$164	90%
Paramount	$169	93%
Buckeye	$172	95%
Molina	$172	95%
Caresource	$176	97%
Mmo	$177 - $197	98%
Ohio Healthy	$178	98%
Amerihealth	$181	100%
Healthsmart	$181	100%
Php	$197	109%
Gms	$230	127%
Medical Benefit Corp	$230	127%
Quality Care Partners	$230	127%
Consociate Health	$247	136%
Frontpath	$296	163%
Managed Care Services	$296	163%
Multiplan	$296	163%
Tertiary Care Network	$296	163%
Three Rivers	$296	163%

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 $214.
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 South Pointe 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.