CMS Price Transparency Data

Psychiatric evaluation (first visit)

Facility: Southwestern Vermont Medical Center

Billing Code: 90791 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 90791
Insurance Median: $162
Cash Discount Price: $217
vs. Medicare Baseline: 0.89x Medicare

The contracted insurance negotiated median rate for a Psychiatric evaluation (first visit) at Southwestern Vermont Medical Center is $162. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $217. Compared to the federal Medicare reimbursement reference rate of $181.34, this hospital’s rate is 0.89x the Medicare baseline. Located in 100 Hospital Drive, Bennington, VT.

Cash / Self-Pay

$217

Average discount available for prompt cash payment at this facility.

Insurance Median

$162

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: $217 (120%)

Insurance Median: $162 (89%)

Cash: $217 (120% of Medicare)

Ins. Median: $162 (89% 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
Bmc	$109	60%
Hne	$109 - $162	60%
Cdphp	$130 - $231	72%
Mvp	$132 - $197	73%
UnitedHealthcare	$132 - $226	73%
Tufts	$146	81%
Aetna	$162	89%
Blue Cross Blue Shield	$162 - $179	89%
Cigna	$162 - $180	89%
Fidelis	$162 - $170	89%
Humana	$162	89%
Wellcare	$162	89%
Harvard Pilgrim	$178	98%
Health New England	$193	106%
Allegiance	$226	125%

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 $217.
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 Southwestern Vermont Medical Center 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.