Psychiatric evaluation (first visit)
Facility: Stormont Vail Hospital
Billing Code: 90791 (CPT)
- CPT Billing Code: 90791
- Insurance Median: $146
- Cash Discount Price: Unavailable
- vs. Medicare Baseline: 0.81x 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 |
|---|---|---|
| Blue Cross Blue Shield | $135 - $169 | 74% |
| Humana | $145 - $148 | 80% |
| Aetna | $145 - $148 | 80% |
Consumer Guidance & Cost Commentary
For this psychiatric evaluation service, the cash price is not available in the data, but the facility's gross charge of $184 serves as the baseline against which other rates are measured. While the facility's negotiated rate of $146 is lower than the gross charge, it is notably higher than the Medicare benchmark of $181.34, which acts as the federal cost baseline for this procedure. This relationship highlights that the commercial negotiated rate exceeds the government-mandated minimum reimbursement, a common pricing dynamic where administrative overhead and contract structures result in higher costs for insured patients compared to the statutory floor set by Medicare.
The data indicates that 3 payers have submitted claims for this service, with allowed amounts ranging from a low of $135 to a high of $169 across various plans. Although the median negotiated rate of $146 is lower than the gross charge, patients with high-deductible plans or those without insurance might find the cash price more advantageous if available, as insurance contracts often include administrative layers that inflate the baseline price. To optimize costs, patients should explicitly request self-pay or prompt-pay discounts during registration, as hospitals frequently offer fee reductions of 20% to 50% for upfront payment to bypass claims processing costs. Additionally, because over 80% of hospital bills contain errors, consumers should demand a full itemized statement before agreeing to pay, ensuring no unbundled codes or services not rendered are included in the final invoice.