CMS Price Transparency Data

Psychiatric evaluation (first visit)

Facility: Clarion Hospital

Billing Code: 90791 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 90791
  • Insurance Median: $165
  • Cash Discount Price: Unavailable
  • vs. Medicare Baseline: 0.91x Medicare
The contracted insurance negotiated median rate for a Psychiatric evaluation (first visit) at Clarion Hospital is $165. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is unavailable. Compared to the federal Medicare reimbursement reference rate of $181.34, this hospital’s rate is 0.91x the Medicare baseline. Located in One Hospital Drive, Clarion, PA.
Cash / Self-Pay
Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median
$165

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%)
Insurance Median: $165 (91%)
Ins. Median: $165 (91% 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.

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
Highmark $153 - $256 84%
Highmark Community Blue $154 85%
Amerihealth $155 85%
Cigna $155 85%
Martin'S Point - Usfhp $155 85%
Medicare (plans) $155 85%
Tricare $155 85%
UnitedHealthcare $155 85%
Aetna $159 - $356 88%
Geisinger $162 89%
Devoted Health Plan $164 90%
The Health Plan $164 - $363 90%
Gateway $165 91%
Pa Health & Wellness $165 91%
American Health Plan $170 94%
Upmc $172 95%
Workers Comp $218 120%
Highmark - Ind.& Managed Care $347 191%
Peak Health $363 200%

Self-Pay Upfront Cash Action Plan

Insurance In-Network Protection Plan

Facility Profile & Credentials

  • Address: One Hospital Drive, Clarion, PA 16214
  • CMS Rating: ★★☆☆☆
  • Ownership Type: Voluntary non-profit - Private
  • Hospital Type: Acute Care Hospitals