Psychiatric evaluation (first visit)
Facility: Ashland Health Center
Billing Code: 90791 (CPT)
- CPT Billing Code: 90791
- Insurance Median: $235
- Cash Discount Price: $188
- vs. Medicare Baseline: 1.30x 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 | $79 | 44% |
| Compalliance-All Plans | $188 | 104% |
| Health Partners Of Kansas-All Plans | $200 | 110% |
| Multiplan-All Plans | $230 | 127% |
| Health Choice-All Plans | $235 | 130% |
| Medicare (plans) | $235 | 130% |
| Aetna | $235 | 130% |
| Medicaid / KanCare | $235 | 130% |
| Medica Mcare - All Plans | $235 | 130% |
| UnitedHealthcare | $235 | 130% |
| Healthy Blue Mcr Adv - All Other Plans | $235 | 130% |
| Providers Care (Wppa)-All Plans | $352 | 194% |
Consumer Guidance & Cost Commentary
For the CPT code 90791, representing a psychiatric evaluation at Ashland Health Center in Ashland, KS, the facility's negotiated rates across all major payers, including Blue Cross Blue Shield and Medicare, are consistently $235. This amount matches the facility's median paid rate and is identical to the cash median of $188, meaning patients paying out-of-pocket receive the same price as those using insurance. While the facility is a Critical Access Hospital with a voluntary non-profit ownership structure, the data does not provide specific county or state average comparisons for this code type, so no regional benchmarking is available for this specific procedure.
It is important to note that while the cash price of $188 is lower than the negotiated rate of $235, patients with high-deductible plans may still find the insurance route beneficial if their out-of-pocket maximum is reached or if the insurance allows a higher allowed amount than the cash price. Additionally, because the cash rate is identical to the negotiated rate, there is no financial incentive to seek a "prompt-pay" discount, which typically ranges from 20% to 50% for upfront payments. Patients should verify their specific plan details and ask the facility directly about any self-pay or prompt-pay discounts before scheduling, as billing systems may default to insurance processing once coverage is on file.