CMS Price Transparency Data

Psychiatric evaluation (first visit)

Facility: Winter Haven Hospital

Billing Code: 90791 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 90791
Insurance Median: $210
Cash Discount Price: $224
vs. Medicare Baseline: 1.16x Medicare

The contracted insurance negotiated median rate for a Psychiatric evaluation (first visit) at Winter Haven Hospital is $210. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $224. Compared to the federal Medicare reimbursement reference rate of $181.34, this hospital’s rate is 1.16x the Medicare baseline. Located in 200 Ave F Ne, Winter Haven, FL.

Cash / Self-Pay

$224

Average discount available for prompt cash payment at this facility.

Insurance Median

$210

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: $224 (124%)

Insurance Median: $210 (116%)

Cash: $224 (124% of Medicare)

Ins. Median: $210 (116% 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
Molina	$63 - $236	35%
Simply Healthcare	$63 - $165	35%
Ultimate Health Plan	$105 - $120	58%
Avmed	$108 - $196	60%
Blue Cross Blue Shield	$112 - $230	62%
Clear Health Alliance	$159	88%
UnitedHealthcare	$160 - $359	88%
Aetna	$161 - $325	89%
Baycareplus	$161	89%
Florida Hospital	$161 - $184	89%
Careplus	$164	90%
Humana	$164 - $202	90%
Freedom Health	$165	91%
Molina Healthcare	$165	91%
Sunshine Health	$165	91%
Florida Community Care	$173	95%
Evolutions	$174 - $371	96%
Freedom	$176	97%
Optimum	$176	97%
Solis Health	$177	98%
Cigna	$184 - $347	101%
Health First	$185	102%
Wellcare	$226	125%
Multiplan	$279 - $319	154%
First Health	$297 - $339	164%
Ambetter / Centene	$349 - $411	192%
United Behavioral Health	$349 - $399	192%

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 $224.
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 Winter Haven 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.