CMS Price Transparency Data

Psychiatric evaluation (first visit)

Facility: Saint Vincent Hospital

Billing Code: 90791 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 90791
Insurance Median: $150
Cash Discount Price: $76
vs. Medicare Baseline: 0.83x Medicare

The contracted insurance negotiated median rate for a Psychiatric evaluation (first visit) at Saint Vincent Hospital is $150. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $76. Compared to the federal Medicare reimbursement reference rate of $181.34, this hospital’s rate is 0.83x the Medicare baseline. Located in 232 West 25Th Street, Erie, PA.

Cash / Self-Pay

$76

Average discount available for prompt cash payment at this facility.

Insurance Median

$150

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: $76 (42%)

Insurance Median: $150 (83%)

Cash: $76 (42% of Medicare)

Ins. Median: $150 (83% 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
UnitedHealthcare	$42 - $4,722	23%
Carelon	$43 - $91	24%
Highmark	$76 - $255	42%
Community Care Behavorial Health Healthchoices	$98 - $181	54%
Community Care Behavorial Health University Of Pittsburgh Medical Center	$98 - $181	54%
Univera	$124 - $182	68%
Life Pittsburgh	$140 - $175	77%
Medicare (plans)	$149 - $180	82%
American Health Plans	$154 - $175	85%
Martin'S Point	$175	97%
University Of Pittsburgh Medical Center	$175	97%
Aetna	$182 - $356	100%
Amerihealth	$184	101%
Blue Cross Blue Shield	$184 - $276	101%
Highmark Wholecare	$185	102%
Humana	$185	102%
Cigna	$187 - $373	103%
Molina	$191	105%
Medical Mutual	$373	206%

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 $76.
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 Saint Vincent 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.