CMS Price Transparency Data

Psychiatric evaluation (first visit)

Facility: UPMC Carlisle

Billing Code: 90791 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 90791
Insurance Median: $279
Cash Discount Price: $358
vs. Medicare Baseline: 1.54x Medicare

The contracted insurance negotiated median rate for a Psychiatric evaluation (first visit) at UPMC Carlisle is $279. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $358. Compared to the federal Medicare reimbursement reference rate of $181.34, this hospital’s rate is 1.54x the Medicare baseline. Located in 361 Alexander Spring Road, Carlisle, PA.

Cash / Self-Pay

$358

Average discount available for prompt cash payment at this facility.

Insurance Median

$279

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: $358 (197%)

Insurance Median: $279 (154%)

Cash: $358 (197% of Medicare)

Ins. Median: $279 (154% 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	$34 - $1,059	19%
Prime Net	$82 - $451	45%
Amerihealth Caritas	$85	47%
Blue Cross Blue Shield	$119 - $480	66%
Keystone Health Plan	$119 - $327	66%
Humana	$154	85%
Aetna	$160 - $292	88%
Cigna	$161 - $466	89%
Geisinger	$161 - $431	89%
Pa Health & Wellness	$166 - $328	92%
Upmc Work Partners	$219	121%
Keystone Autism Services	$246	136%
Wellspan Population Health	$388 - $478	214%
Upmc Health Plan	$418	231%
Multiplan	$507	280%

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 $358.
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 Carlisle 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.