CMS Price Transparency Data

Psychiatric evaluation (first visit)

Facility: Jefferson Hospital

Billing Code: 90791 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 90791
Insurance Median: $140
Cash Discount Price: $80
vs. Medicare Baseline: 0.77x Medicare

The contracted insurance negotiated median rate for a Psychiatric evaluation (first visit) at Jefferson Hospital is $140. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $80. Compared to the federal Medicare reimbursement reference rate of $181.34, this hospital’s rate is 0.77x the Medicare baseline. Located in 565 Coal Valley Road, Jefferson Hills, PA.

Cash / Self-Pay

$80

Average discount available for prompt cash payment at this facility.

Insurance Median

$140

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: $80 (44%)

Insurance Median: $140 (77%)

Cash: $80 (44% of Medicare)

Ins. Median: $140 (77% 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	$42 - $3,040	23%
Carelon	$43 - $91	24%
Highmark	$72 - $254	40%
Community Care Behavorial Health Healthchoices	$98 - $150	54%
Community Care Behavorial Health University Of Pittsburgh Medical Center	$98 - $150	54%
Univera	$124 - $182	68%
Life Pittsburgh	$140 - $155	77%
Medicare (plans)	$149 - $159	82%
American Health Plans	$154 - $155	85%
Martin'S Point	$155	85%
University Of Pittsburgh Medical Center	$155	85%
Aetna	$161 - $377	89%
Amerihealth	$162	89%
Highmark Wholecare	$164	90%
Humana	$164	90%
Cigna	$165 - $380	91%
Molina	$168	93%
Medical Mutual	$380	210%

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 $80.
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 Jefferson 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.