CMS Price Transparency Data

Psychiatric evaluation (first visit)

Facility: Pinckneyville Community Hospital

Billing Code: 90791 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 90791
  • Insurance Median: $305
  • Cash Discount Price: $395
  • vs. Medicare Baseline: 1.68x Medicare
The contracted insurance negotiated median rate for a Psychiatric evaluation (first visit) at Pinckneyville Community Hospital is $305. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $395. Compared to the federal Medicare reimbursement reference rate of $181.34, this hospital’s rate is 1.68x the Medicare baseline. Located in 5383 State Route 154, Pinckneyville, IL.
Cash / Self-Pay
$395

Average discount available for prompt cash payment at this facility.

Insurance Median
$305

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: $395 (218%)
Insurance Median: $305 (168%)
Cash: $395 (218% of Medicare)
Ins. Median: $305 (168% 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
Humana $137 - $155 76%
Umwa Mcr Adv - All Plans $137 - $155 76%
UnitedHealthcare $137 - $344 76%
Wellcare Mcr Adv - All Plans $137 - $155 76%
Aetna $139 - $1,355 77%
Blue Cross Blue Shield $266 - $1,355 147%
Healthlink Hmo $290 - $330 160%
Phcs - All Other Plans $303 - $344 167%
Cigna $305 - $346 168%
Healthlink Ppo - All Other Plans $305 - $346 168%
Healthlink Work Comp $305 - $346 168%
Phcs Savility $314 - $357 173%
Multiplan - All Plans $332 - $378 183%
Ambetter / Centene $1,355 747%
Medicaid / KanCare $1,355 747%

Self-Pay Upfront Cash Action Plan

Insurance In-Network Protection Plan

Facility Profile & Credentials

  • Address: 5383 State Route 154, Pinckneyville, IL 62274
  • CMS Rating: No CMS Rating
  • Ownership Type: Government - Hospital District or Authority
  • Hospital Type: Critical Access Hospitals