Psychiatric evaluation (first visit)
Facility: Saint Luke'S South Hospital
Billing Code: 90791 (CPT)
- CPT Billing Code: 90791
- Insurance Median: $249
- Cash Discount Price: $255
- vs. Medicare Baseline: 1.37x 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 |
|---|---|---|
| UnitedHealthcare | $56 - $192 | 31% |
| Humana | $136 - $278 | 75% |
| Cigna | $137 - $323 | 76% |
| Medicaid / KanCare | $137 - $205 | 76% |
| Transplants-Case Rates [5750] | $149 - $425 | 82% |
| Blue Cross Blue Shield | $191 - $940 | 105% |
| Aetna | $233 - $404 | 128% |
| Commercial-Contracted [8000] | $252 - $344 | 139% |
| First Health [5512] | $252 | 139% |
Consumer Guidance & Cost Commentary
For the CPT code 90791, representing a psychiatric evaluation at Saint Luke's South Hospital in Overland Park, KS, the facility's cash median price is $255.00, which is notably lower than the gross charge of $425.00. While the facility's negotiated rates for commercial payers like UnitedHealthcare and Humana range from $56 to $278, these amounts often exceed the cash price, making self-pay a potentially more affordable option for patients with high-deductible plans. It is important to note that the facility's negotiated median of $249.00 is slightly below the cash rate, but commercial contracts can still result in higher out-of-pocket costs depending on the specific plan. Patients should verify their deductible status before scheduling, as paying the full negotiated rate may be required if the deductible has not yet been met.
When evaluating the cost against federal benchmarks, the Medicare amount for this service is $181.34, with a benchmarking ratio of 1.4, indicating the facility charges 40% more than the federal baseline. This markup is consistent with commercial pricing dynamics where negotiated rates often average 200% to 300% of Medicare rates, though fair pricing is typically defined as 120% to 150%. To minimize costs, patients should inquire about "prompt-pay" discounts, which can reduce bills by 20% to 50% for upfront payment, effectively bypassing the administrative overhead associated with insurance claims. Additionally, since over 80% of hospital bills contain errors, requesting a detailed, itemized audit before finalizing payment is a