CMS Price Transparency Data

Psychiatric evaluation (first visit)

Facility: UPMC Pinnacle Hospitals

Billing Code: 90791 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 90791
Insurance Median: $418
Cash Discount Price: $514
vs. Medicare Baseline: 2.31x Medicare

The contracted insurance negotiated median rate for a Psychiatric evaluation (first visit) at UPMC Pinnacle Hospitals is $418. 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 2.31x the Medicare baseline. Located in 409 South Second Street, Harrisburg, PA.

Cash / Self-Pay

$514

Average discount available for prompt cash payment at this facility.

Insurance Median

$418

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: $418 (231%)

Cash: $514 (283% of Medicare)

Ins. Median: $418 (231% 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 231% of the Medicare baseline (a markup of 131%). 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
UnitedHealthcare	$34 - $169	19%
Blue Cross Blue Shield	$119 - $1,801	66%
Keystone Health Plan	$119 - $647	66%
Prime Net	$144 - $838	79%
Humana	$163	90%
Aetna	$165 - $684	91%
Cigna	$166	92%
Pa Health & Wellness	$171	94%
Upmc Work Partners	$219	121%
Geisinger	$328 - $613	181%
Intergroup	$388 - $948	214%
Upmc Health Plan	$418 - $780	231%
Wellspan Population Health	$507 - $948	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 $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 Pinnacle Hospitals 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.