CMS Price Transparency Data

Psychiatric evaluation (first visit)

Facility: Prisma Health Tuomey Hospital

Billing Code: 90791 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 90791
Insurance Median: $348
Cash Discount Price: $355
vs. Medicare Baseline: 1.92x Medicare

The contracted insurance negotiated median rate for a Psychiatric evaluation (first visit) at Prisma Health Tuomey Hospital is $348. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $355. Compared to the federal Medicare reimbursement reference rate of $181.34, this hospital’s rate is 1.92x the Medicare baseline. Located in 129 N Washington St, Sumter, SC.

Cash / Self-Pay

$355

Average discount available for prompt cash payment at this facility.

Insurance Median

$348

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: $355 (196%)

Insurance Median: $348 (192%)

Cash: $355 (196% of Medicare)

Ins. Median: $348 (192% 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
Medicaid / KanCare	$84 - $110	46%
UnitedHealthcare	$84 - $349	46%
Humana	$112 - $410	62%
Prisma Health Seniorcare Pace - Midlands [5400]	$127	70%
Prisma Health Seniorcare Pace-Upstate [5200]	$127	70%
Blue Cross Blue Shield	$147 - $613	81%
Bluechoice [810]	$147 - $612	81%
Tricare	$148	82%
Companion Benefit Alternatives [2983]	$162	89%
Carelon Behavioral Health [3180]	$175	97%
Promise Health Plan Contracted [2401]	$191 - $328	105%
Orangeburg Senior Helping Center Pace [5401]	$218	120%
Golden Rule Insurance Company [2991]	$244 - $349	135%
Oxford Health Plans [2992]	$244 - $349	135%
Zzumr-Salt Lake City Ut [3169]	$244 - $349	135%
Scdc-Sc Dept Of Corrections [7232]	$255 - $348	141%
Bob Jones Univ-Pai [821]	$328	181%
Aetna	$349 - $431	192%
Meritain Health Contracted [2200]	$349 - $431	192%
Preferred Administrators Contracted [2839]	$382	211%
Medcost [2940]	$404 - $453	223%
Atlantic Packaging Contracted [4833]	$410	226%
Cigna	$419	231%
Aps Healthcare System [2981]	$437	241%
Multiplan/Phcs Contracted [2950]	$486	268%
Vsp Vision Care [2986]	$491	271%
First Health Contracted [2952]	$508	280%
Furman Int/Allen University Student [2951]	$508	280%
Quiktrip-First Health [3067]	$508	280%
Planned Administrators [820]	$613	338%

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 $355.
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 Prisma Health Tuomey 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.