CMS Price Transparency Data
Psychiatric evaluation (first visit)
Facility: Pennsylvania Hospital
Billing Code: 90791 (CPT)
Factual Cost Summary (Answer Capsule)
- CPT Billing Code: 90791
- Insurance Median: $172
- Cash Discount Price: $322
- vs. Medicare Baseline: 0.95x Medicare
The contracted insurance negotiated median rate for a Psychiatric evaluation (first visit) at Pennsylvania Hospital is $172. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $322. Compared to the federal Medicare reimbursement reference rate of $181.34, this hospital’s rate is 0.95x the Medicare baseline. Located in 800 Spruce Street, Philadelphia, PA.
Cash / Self-Pay
$322
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: $322 (178%)
Insurance Median: $172 (95%)
Cash: $322 (178% 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.
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 |
|---|---|---|
| Horizon Nj Health | $26 - $62 | 14% |
| Medicaid / KanCare | $27 - $350 | 15% |
| Keystone Mercy Health Plan | $30 - $70 | 17% |
| UnitedHealthcare | $31 - $999 | 17% |
| Pgm - Regie De L'Assurance Maladie Quebec | $35 - $80 | 19% |
| Upmc | $38 - $350 | 21% |
| Preferred Health Care Eliance | $39 - $91 | 22% |
| Blue Cross Blue Shield | $41 - $594 | 23% |
| Aetna | $42 - $350 | 23% |
| Cigna | $51 - $191 | 28% |
| Pgm - Kuwait Defense | $53 - $158 | 29% |
| Devon | $57 - $158 | 31% |
| Qualcare | $57 - $133 | 31% |
| Coventry | $60 - $178 | 33% |
| Pgm - Chop | $60 - $140 | 33% |
| Wissahickon Hospice | $60 - $140 | 33% |
| Ibc Commercial Hpn | $61 - $594 | 34% |
| Keystone Hmo Proactive | $62 - $594 | 34% |
| Healthamerica/Coventry | $68 - $172 | 37% |
| Health Partners | $69 - $350 | 38% |
| Quest Behavioral Health | $70 - $350 | 39% |
| Olympus | $74 - $170 | 41% |
| First Health Global | $76 - $175 | 42% |
| Urn-Cancer Resource Services | $76 - $175 | 42% |
| Health Net | $91 - $210 | 50% |
| Pgm - Royal Embassy Of Saudi Arabia | $91 - $210 | 50% |
| Pgm - Embassy Of Qatar | $98 - $228 | 54% |
| Pgm - Ontario Ministry Of Health And Long-Term Care (Ohip) | $98 - $228 | 54% |
| Pgm - Embassy Of The United Emirates/Ipc | $106 - $245 | 58% |
| Devon Health Services Inc | $121 - $280 | 67% |
| Health America/Ccn | $121 - $280 | 67% |
| Humana | $121 - $280 | 67% |
| Intergroup | $121 - $280 | 67% |
| Pgm - Kuwait Health Division | $121 - $280 | 67% |
| Pgm - Kuwait Oil | $121 - $280 | 67% |
| Preferred Care | $121 - $280 | 67% |
| Commercial Other | $151 - $350 | 83% |
| Community Behavioral Health | $151 - $350 | 83% |
| International Pfs | $151 - $350 | 83% |
| United Behavioral Health | $151 - $350 | 83% |
| Workers Compensation | $151 - $350 | 83% |
| Medicare (plans) | $186 - $189 | 103% |
| Philadelphia Va Medical Center | $186 | 103% |
| Tricare | $187 | 103% |
| Ibc | $189 - $594 | 104% |
| Geisinger Health Plan | $191 - $589 | 105% |
| Pa Health And Wellness | $195 - $306 | 108% |
| Penn Life (Living Independently For Elders) | $195 | 108% |
| Clover Health Plan | $200 | 110% |
| Keystone First | $206 | 114% |
| Us Family Health Plan | $215 | 119% |
| Gateway Health Plan | $230 | 127% |
| Elap | $264 | 146% |
| Claims Watcher | $297 - $334 | 164% |
| Oscar Health Plan | $316 | 174% |
| Centivo | $334 | 184% |
| Elap Services | $345 | 190% |
| Highmark | $390 | 215% |
| Penn Global Medicine | $492 | 271% |