Psychiatric evaluation (first visit)
Facility: Nemaha Valley Community Hospital
Billing Code: 90791 (CPT)
- CPT Billing Code: 90791
- Insurance Median: $194
- Cash Discount Price: $194
- vs. Medicare Baseline: 1.07x 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 |
|---|---|---|
| Humana | $95 | 52% |
| Partners Direct Health - All Plans | $112 | 62% |
| Blue Cross Blue Shield | $169 | 93% |
| Aetna | $183 - $329 | 101% |
| Multiplan - All Plans | $194 | 107% |
| Health Partners - All Plans | $204 | 112% |
| Midlands Choice - All Plans | $204 | 112% |
| Celtic Comm Exch - All Plans | $329 | 181% |
Consumer Guidance & Cost Commentary
For CPT code 90791, representing a psychiatric evaluation at Nemaha Valley Community Hospital in Seneca, Kansas, the cash median price is $194.00, which aligns closely with the facility's median negotiated rate of $194.00. This cash price is notably lower than the gross charge of $215.00 and represents a significant discount compared to the Medicare benchmark of $181.34, with the cash rate being approximately 107% of the Medicare amount. While commercial payers negotiate rates ranging from $95 to $329 depending on the plan, patients with high-deductible plans may find the cash price more advantageous if their insurance negotiated rates exceed this figure. It is important to note that while the facility is a Critical Access Hospital with voluntary non-profit ownership, patients should verify their specific plan's allowed amount before scheduling, as in-network rates can vary significantly across different insurers.
To ensure you are receiving the most accurate and fair billing, it is recommended to request an itemized bill that details every CPT code and unit cost rather than accepting a summary invoice that may obscure individual charges. Since over 80% of hospital bills contain errors such as unbundled codes or services not rendered, a line-by-line review is the most effective way to identify and dispute any inaccuracies. Additionally, if you choose to pay out-of-pocket, ask the billing department about prompt-pay discounts, which can reduce the total cost by 20% to 50% when paid in full upfront, bypassing the administrative overhead associated with insurance claims processing. Always confirm your deductible status before proceeding, as paying the full negotiated rate