CMS Price Transparency Data

Psychiatric evaluation (first visit)

Facility: Cleveland Clinic Indian River Hospital

Billing Code: 90791 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 90791
Insurance Median: $161
Cash Discount Price: $583
vs. Medicare Baseline: 0.89x Medicare

The contracted insurance negotiated median rate for a Psychiatric evaluation (first visit) at Cleveland Clinic Indian River Hospital is $161. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $583. Compared to the federal Medicare reimbursement reference rate of $181.34, this hospital’s rate is 0.89x the Medicare baseline. Located in 1000 36Th St, Vero Beach, FL.

Cash / Self-Pay

$583

Average discount available for prompt cash payment at this facility.

Insurance Median

$161

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: $583 (321%)

Insurance Median: $161 (89%)

Cash: $583 (321% of Medicare)

Ins. Median: $161 (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
Cigna	$100 - $164	55%
Magellan	$115 - $247	63%
Aetna	$121 - $1,245	67%
Value Options	$122 - $145	67%
UnitedHealthcare	$125	69%
Amerihealth	$132	73%
Medicaid / KanCare	$132	73%
Molina	$132	73%
Wellcare	$132 - $161	73%
Avmed	$145 - $369	80%
Blue Cross Blue Shield	$145 - $161	80%
Careplus	$145 - $161	80%
United	$145 - $995	80%
Freedom Health	$153 - $161	84%
Independent Living Systems	$153 - $169	84%
Wellmed	$153 - $161	84%
Clear Spring Health	$157 - $221	87%
Carelon Bh Strategies	$161	89%
Humana	$161	89%
Devoted Health	$177	98%
Bmi	$227	125%
Clarity Health	$268 - $899	148%
The Legacy Companies	$268 - $899	148%
Multiplan	$330	182%
National Provider Network	$968	534%
Three Rivers	$968	534%
Consociate Health	$1,037	572%

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 $583.
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 Cleveland Clinic Indian River 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.