CMS Price Transparency Data

Psychiatric evaluation (first visit)

Facility: St Anthony Regional Hospital & Nursing Home

Billing Code: 90791 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 90791
Insurance Median: $136
Cash Discount Price: $154
vs. Medicare Baseline: 0.75x Medicare

The contracted insurance negotiated median rate for a Psychiatric evaluation (first visit) at St Anthony Regional Hospital & Nursing Home is $136. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $154. Compared to the federal Medicare reimbursement reference rate of $181.34, this hospital’s rate is 0.75x the Medicare baseline. Located in 311 South Clark Street, Carroll, IA.

Cash / Self-Pay

$154

Average discount available for prompt cash payment at this facility.

Insurance Median

$136

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: $154 (85%)

Insurance Median: $136 (75%)

Cash: $154 (85% of Medicare)

Ins. Median: $136 (75% 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
Aetna	$54 - $186	30%
Humana	$54 - $258	30%
Medica Mcr - All Plans	$54 - $136	30%
UnitedHealthcare	$54 - $218	30%
Va Ccn - All Plans	$54 - $136	30%
Wellpoint Mcr Adv	$54 - $136	30%
Ia Total Care Mcr	$56 - $140	31%
Ia Total Care Mcaid	$62 - $304	34%
Wellpoint Mcaid - All Other Plans	$62 - $304	34%
Molina Mcaid - All Plans	$63 - $310	35%
Ia Total Care Comm - All Other Plans	$70 - $177	39%
Midlands Choice - All Plans	$141 - $166	78%
Wellmark Hmo	$151 - $208	83%
Wellmark Ppo-All Other Plans	$166 - $208	92%

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 $154.
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 St Anthony Regional Hospital & Nursing Home 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.