Psychiatric evaluation (first visit)
Facility: Holton Community Hospital
Billing Code: 90791 (CPT)
- CPT Billing Code: 90791
- Insurance Median: $212
- Cash Discount Price: $191
- vs. Medicare Baseline: 1.17x 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 | $135 - $178 | 74% |
| Aetna | $135 - $255 | 74% |
| Humana | $136 | 75% |
| Kansas Superior Select - All Plans | $138 | 76% |
| Blue Cross Blue Shield | $168 | 93% |
| Preferred Health Fn Select - All Other Plans | $212 | 117% |
| Preferred Health Freedom | $212 | 117% |
| Preferred Health Professionals | $212 | 117% |
| Wppa Providers - All Plans | $242 | 133% |
| Medicaid / KanCare | $255 | 141% |
Consumer Guidance & Cost Commentary
For the psychiatric evaluation (first visit) at Holton Community Hospital in Holton, Kansas, the cash price is $191.00, which is lower than the facility's negotiated rates of $212.00. While the facility is a Critical Access Hospital with a voluntary non-profit ownership structure, patients with high-deductible plans may find paying the cash price directly more cost-effective than relying on insurance, as the negotiated rates exceed the cash amount. It is important to note that the cash price of $191.00 is significantly lower than the Medicare benchmark of $181.34, suggesting that for this specific service, the cash rate is actually higher than the federal baseline, though it remains below the commercial negotiated rates. Patients should verify if their specific insurance plan has a deductible that would otherwise result in a higher out-of-pocket cost than the cash price.
When reviewing the billing statement, consumers should request an itemized audit to ensure no errors, double-billing, or unbundled codes are present, as over 80% of hospital bills contain mistakes that can be corrected with a formal written dispute. Although the facility offers a cash price of $191.00, patients should ask about "prompt-pay" discounts, which can reduce the bill by 20% to 50% if paid in full upfront, bypassing the administrative costs associated with insurance claims processing. Additionally, while the No Surprises Act protects against balance billing for out-of-network services at in-network facilities, patients should confirm their plan's status and avoid signing away rights to dispute surprise bills. For this service, the lowest allowed amount among payers is $135, but