Psychiatric evaluation (first visit)
Facility: Pratt Regional Medical Center
Billing Code: 90791 (CPT)
- CPT Billing Code: 90791
- Insurance Median: $354
- Cash Discount Price: $302
- vs. Medicare Baseline: 1.95x Medicare
Average discount available for prompt cash payment at this facility.
Median negotiated contract rate across all mapped commercial carriers.
Standard federal government reimbursement rate for this code.
Visual Cost Comparison vs. 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.
Commercial Insurance Negotiated Rates
Negotiated contract ranges established by major commercial carriers at this facility.
| Carrier / Plan Group | Contract Rate Range | vs. Medicare Reference |
|---|---|---|
| Celtic Insurance Company | $148 | 82% |
| Healthy Blue | $152 | 84% |
| UnitedHealthcare | $163 - $518 | 90% |
| Christian Health Aid | $266 - $381 | 147% |
| Health Partners Of Kansas | $301 - $432 | 166% |
| Aetna | $319 - $457 | 176% |
| Choicecare | $354 - $508 | 195% |
Consumer Guidance & Cost Commentary
For the CPT code 90791, representing a psychiatric evaluation at Pratt Regional Medical Center in Pratt, Kansas, the facility's cash median price is $302.00. This cash rate is notably lower than the negotiated rates charged to insurance payers, with the lowest negotiated amount being $148 and the highest reaching $518 across seven different plans. While commercial insurance contracts often result in higher out-of-pocket costs due to administrative overhead and network tiering, patients with high-deductible plans may find paying the cash price directly more economical if their insurance allowed amount exceeds $302.00. It is important to note that the facility offers a cash median of $302.00, which serves as a baseline for self-pay patients, though specific self-pay or prompt-pay discounts should be confirmed directly with the hospital before scheduling to ensure the lowest possible rate.
The Medicare benchmark for this service is $181.34, which acts as a scientifically validated baseline for the true cost of care delivery. Commercial negotiated rates frequently exceed this benchmark, often ranging between 200% and 300% of the Medicare amount due to multi-layered administrative structures and contract dynamics. In this instance, the facility's ownership is proprietary, and while the data does not provide specific state or county average comparisons for this code, the significant gap between the Medicare rate and the highest negotiated rate highlights the potential for substantial variation in pricing depending on the insurance carrier. Consumers should be aware that balance billing is generally prohibited for emergency care and non-emergency services at in-network facilities under the No Surprises Act, but patients should still request an itemized bill to verify that all