CMS Price Transparency Data

Psychiatric evaluation (first visit)

Facility: Punxsutawney Area Hospital

Billing Code: 90791 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 90791
Insurance Median: $172
Cash Discount Price: $145
vs. Medicare Baseline: 0.95x Medicare

The contracted insurance negotiated median rate for a Psychiatric evaluation (first visit) at Punxsutawney Area Hospital is $172. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $145. Compared to the federal Medicare reimbursement reference rate of $181.34, this hospital’s rate is 0.95x the Medicare baseline. Located in 81 Hillcrest Drive, Punxsutawney, PA.

Cash / Self-Pay

$145

Average discount available for prompt cash payment at this facility.

Insurance Median

$172

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: $145 (80%)

Insurance Median: $172 (95%)

Cash: $145 (80% of Medicare)

Ins. Median: $172 (95% 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	$29 - $185	16%
Highmark Wholecare	$102 - $172	56%
Upmc Health Plan	$107 - $228	59%
Ambetter / Centene	$123 - $195	68%
Highmark	$123 - $982	68%
Tricare	$147 - $168	81%
Aetna	$167 - $407	92%
Amerihealth Caritas	$167 - $182	92%
Geisinger Health Plan	$170 - $186	94%
United Mine Workers Of America	$170 - $185	94%
Cigna	$182 - $270	100%
Humana	$182	100%
Pa Health And Wellness Commercial	$212 - $370	117%
Geisinger	$238 - $518	131%
Pa Workers Compensation	$307 - $455	169%

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 $145.
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 Punxsutawney Area 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.