CMS Price Transparency Data

Psychiatric evaluation (first visit)

Facility: Valley West Community Hospital

Billing Code: 90791 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 90791
Insurance Median: $129
Cash Discount Price: $224
vs. Medicare Baseline: 0.71x Medicare

The contracted insurance negotiated median rate for a Psychiatric evaluation (first visit) at Valley West Community Hospital is $129. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $224. Compared to the federal Medicare reimbursement reference rate of $181.34, this hospital’s rate is 0.71x the Medicare baseline. Located in 11 East Pleasant Avenue, Sandwich, IL.

Cash / Self-Pay

$224

Average discount available for prompt cash payment at this facility.

Insurance Median

$129

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: $224 (124%)

Insurance Median: $129 (71%)

Cash: $224 (124% of Medicare)

Ins. Median: $129 (71% 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	$28 - $400	15%
Global Excel [1712]	$28 - $93	15%
Humana	$28 - $93	15%
Aetna	$38 - $340	21%
Health'S Finest Network [126]	$67 - $416	37%
Cigna	$68 - $237	37%
UnitedHealthcare	$75 - $490	41%
The Alliance [1703]	$81 - $266	45%
Choicecare [177]	$100 - $330	55%
Healthlink [125]	$112 - $368	62%
Multiplan/Phcs [142]	$119 - $490	66%
First Health Plan [6034]	$149 - $490	82%

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 $224.
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 Valley West Community 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.