CMS Price Transparency Data

Psychiatric evaluation (first visit)

Facility: St Mary's Hospital

Billing Code: 90791 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 90791
Insurance Median: $173
Cash Discount Price: $136
vs. Medicare Baseline: 0.95x Medicare

The contracted insurance negotiated median rate for a Psychiatric evaluation (first visit) at St Mary's Hospital is $173. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $136. Compared to the federal Medicare reimbursement reference rate of $181.34, this hospital’s rate is 0.95x the Medicare baseline. Located in 701 Lewiston St, Cottonwood, ID.

Cash / Self-Pay

$136

Average discount available for prompt cash payment at this facility.

Insurance Median

$173

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: $136 (75%)

Insurance Median: $173 (95%)

Cash: $136 (75% of Medicare)

Ins. Median: $173 (95% 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
Blue Cross Blue Shield	$48 - $244	26%
Aetna	$55 - $232	30%
Medicare (plans)	$55 - $204	30%
Regence Blue Shield Mcr	$55 - $204	30%
Tricare	$55 - $204	30%
UnitedHealthcare	$55 - $204	30%
Veterans Admin - All Plans	$55 - $204	30%
Nimiipuu Mcr Adv - Allplans	$56 - $206	31%
Idaho Phys Network - All Plans	$64 - $237	35%
Corizon Correctional - All Plans	$65 - $239	36%
First Choice- All Plans	$66 - $244	36%
Geha - All Plans	$66 - $242	36%
Multiplan - All Plans	$66 - $242	36%
Regence Blue Shield - All Other Plans	$68 - $249	37%

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 $136.
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 Mary's 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.