CMS Price Transparency Data

Psychiatric evaluation (first visit)

Facility: UPMC Somerset

Billing Code: 90791 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 90791
Insurance Median: $328
Cash Discount Price: $514
vs. Medicare Baseline: 1.81x Medicare

The contracted insurance negotiated median rate for a Psychiatric evaluation (first visit) at UPMC Somerset is $328. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $514. Compared to the federal Medicare reimbursement reference rate of $181.34, this hospital’s rate is 1.81x the Medicare baseline. Located in 225 South Center Avenue, Somerset, PA.

Cash / Self-Pay

$514

Average discount available for prompt cash payment at this facility.

Insurance Median

$328

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: $514 (283%)

Insurance Median: $328 (181%)

Cash: $514 (283% of Medicare)

Ins. Median: $328 (181% 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	$30 - $153	17%
Blue Cross Blue Shield	$152 - $288	84%
Amerihealth Caritas	$153	84%
Upmc Health Plan	$153 - $502	84%
Highmark Wholecare (Prev Gateway)	$165	91%
Upmc Work Partners	$209	115%
Geisinger	$235 - $613	130%
Aetna	$239 - $446	132%
Multiplan	$298 - $725	164%
Galaxy Health Plan	$388 - $725	214%
Humana	$448 - $836	247%

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 $514.
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 UPMC Somerset 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.