CMS Price Transparency Data

Psychiatric evaluation (first visit)

Facility: Mc Donough District Hospital

Billing Code: 90791 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 90791
  • Insurance Median: $284
  • Cash Discount Price: $193
  • vs. Medicare Baseline: 1.57x Medicare
The contracted insurance negotiated median rate for a Psychiatric evaluation (first visit) at Mc Donough District Hospital is $284. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $193. Compared to the federal Medicare reimbursement reference rate of $181.34, this hospital’s rate is 1.57x the Medicare baseline. Located in 525 East Grant Street, Macomb, IL.
Cash / Self-Pay
$193

Average discount available for prompt cash payment at this facility.

Insurance Median
$284

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: $193 (106%)
Insurance Median: $284 (157%)
Cash: $193 (106% of Medicare)
Ins. Median: $284 (157% 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.

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 $72 - $349 40%
Health Alliance $86 - $311 47%
Hfn $135 - $314 74%
UnitedHealthcare $135 - $314 74%
Humana $143 - $314 79%
Medicaid / KanCare $143 - $349 79%
Medicare (plans) $143 - $179 79%
Meridian $143 - $179 79%
Molina $143 - $349 79%
Mutual Medical $143 - $349 79%
Veteran Affairs $143 - $179 79%
Tricare $167 92%
Springfield Health $248 - $286 137%
Consociate $257 - $297 142%
Trilogy $257 - $297 142%
Blue Choice $272 - $314 150%
Current Health $272 - $314 150%
Healthlink $272 - $328 150%
Preferred Plan $287 - $332 158%
Blue Cross Blue Shield $302 - $349 167%

Self-Pay Upfront Cash Action Plan

Insurance In-Network Protection Plan

Facility Profile & Credentials

  • Address: 525 East Grant Street, Macomb, IL 61455
  • CMS Rating: ★★★☆☆
  • Ownership Type: Government - Hospital District or Authority
  • Hospital Type: Acute Care Hospitals