Psychiatric evaluation (first visit)
Facility: Boston Children's Hospital
Billing Code: 90791 (CPT)
- CPT Billing Code: 90791
- Insurance Median: $668
- Cash Discount Price: $968
- vs. Medicare Baseline: 3.68x Medicare
Average discount available for prompt cash payment at this facility.
Median negotiated contract rate across all mapped commercial carriers.
Standard federal government reimbursement rate for this code.
Visual Cost Comparison vs. 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.
Elevated Commercial Rate Alert (Value-Gap)
The negotiated rate at this facility is 368% of the Medicare baseline (a markup of 268%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.
Out-of-Pocket Cost Estimator
Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash rate.
Commercial Insurance Negotiated Rates
Negotiated contract ranges established by major commercial carriers at this facility.
| Carrier / Plan Group | Contract Rate Range | vs. Medicare Reference |
|---|---|---|
| Cdphp | $316 - $1,117 | 174% |
| Harvard Pilgrim | $328 - $888 | 181% |
| Blue Cross Blue Shield | $364 - $868 | 201% |
| United | $386 - $1,098 | 213% |
| Aetna | $387 - $1,102 | 213% |
| Mgb/Allways | $392 - $971 | 216% |
| Tufts Public Plan | $396 - $809 | 218% |
| United Ri Nj Ny | $406 - $828 | 224% |
| Ambetter / Centene | $408 - $830 | 225% |
| Carelon Strategies/Bhs | $419 - $854 | 231% |
| UnitedHealthcare | $419 - $1,117 | 231% |
| Carelon/Beacon | $484 - $986 | 267% |
| Fallon | $492 - $1,013 | 271% |
| Health New England | $521 - $1,062 | 287% |
| Interlink Transplant | $548 - $1,117 | 302% |
| Cigna | $548 - $1,231 | 302% |
| Ets/Lifetrac | $548 - $1,117 | 302% |
| Community Health Options | $580 - $1,183 | 320% |
| Humana | $580 - $1,183 | 320% |
| Coventry/Hcvm/First Health | $593 - $1,209 | 327% |
| Multiplan/Phcs | $593 - $1,248 | 327% |
Consumer Guidance & Cost Commentary
For this psychiatric evaluation at Boston Children's Hospital, the cash charge of $968 is significantly higher than the Medicare benchmark of $181.34, which serves as the objective baseline for true healthcare costs. While the facility lists a cash price of $968, patients with high-deductible plans or those without insurance should note that paying the full cash rate may not be the most economical option if their insurance negotiated rate exceeds this amount; however, in this specific case, the commercial negotiated rate is $668, which is lower than the cash price. It is crucial to verify with the hospital whether a "self-pay" or "prompt-pay" discount is available before scheduling, as upfront payment can sometimes bypass the standard billing cycle to reduce the final amount owed.
The data reflects 21 different payers with negotiated rates ranging from a low of $316 to a high of $1,248, meaning individual out-of-pocket costs vary widely depending on the specific insurance plan. For instance, plans like Cdphp and Tufts Public Plan have the lowest high-end rates at $1,117 and $809 respectively, while others such as Multiplan/Phcs and Coventry/Hcvm/First Health have high-end rates reaching $1,248 and $1,209. Because commercial rates often include administrative overhead and are influenced by contract dynamics, patients should avoid accepting summary bills and instead request a detailed itemized CPT-coded statement to identify any errors, unbundled charges, or services not rendered. If a balance bill arises from an out-of-network ancillary service, patients can protect themselves by disputing the claim with their insurer and