CMS Price Transparency Data

Psychiatric evaluation (first visit)

Facility: Caribou Medical Center

Billing Code: 90791 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 90791
Insurance Median: $301
Cash Discount Price: $222
vs. Medicare Baseline: 1.66x Medicare

The contracted insurance negotiated median rate for a Psychiatric evaluation (first visit) at Caribou Medical Center is $301. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $222. Compared to the federal Medicare reimbursement reference rate of $181.34, this hospital’s rate is 1.66x the Medicare baseline. Located in 300 South 3Rd West, Soda Springs, ID.

Cash / Self-Pay

$222

Average discount available for prompt cash payment at this facility.

Insurance Median

$301

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: $222 (122%)

Insurance Median: $301 (166%)

Cash: $222 (122% of Medicare)

Ins. Median: $301 (166% 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
Humana	$143	79%
Pacific Source Mcr Adv	$143	79%
Regence Blue Shield Mcr	$143	79%
Select Health Mcr Adv	$143	79%
Select Health/Bright Path Mcr Adv	$143	79%
Blue Cross Blue Shield	$144 - $311	79%
Aetna	$200 - $311	110%
First Choice Health-All Plans	$286	158%
Bc Qualified Hp (Qhp)	$295	163%
Deseret Healthcare-All Plans	$301	166%
Pacific Source-All Other Plans	$308	170%
UnitedHealthcare	$308	170%
Cigna	$311	172%
Montana Health Co-Op-All Plans	$311	172%
Regence Blue Shield-All Other Plans	$311	172%
Select Health-All Other Plans	$311	172%

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 $222.
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 Caribou 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.