Psychiatric evaluation (first visit)
Facility: Hiawatha Community Hospital
Billing Code: 90791 (CPT)
- CPT Billing Code: 90791
- Insurance Median: $327
- Cash Discount Price: $420
- vs. Medicare Baseline: 1.80x 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 |
|---|---|---|
| Aetna | $155 - $339 | 85% |
| UnitedHealthcare | $155 - $361 | 85% |
| Humana | $157 | 87% |
| Blue Cross Blue Shield | $161 - $169 | 89% |
| Ambetter / Centene | $186 | 103% |
| Centrus Health Direct - All Plans | $315 | 174% |
| Oscar - All Plans | $315 | 174% |
| Preferred Hlth - All Plans | $378 | 208% |
| Wppa Providrs Care - All Plans | $399 | 220% |
| Cigna | $399 | 220% |
| Midlands Choice - All Plans | $407 | 224% |
| Multiplan - All Plans | $407 | 224% |
| Healthy Blue Mcaid - All Plans | $420 | 232% |
Consumer Guidance & Cost Commentary
For a psychiatric evaluation (first visit) at Hiawatha Community Hospital in Hiawatha, KS, the cash price is $420.00, which matches the facility's gross charge and the median paid by cash payers. This rate is significantly higher than the state average, reflecting a markup of 1.8 times the Medicare benchmark of $181.34. While commercial insurance plans like Aetna and UnitedHealthcare negotiate rates ranging from $155 to $361, these negotiated amounts often exceed the cash price for patients with high-deductible plans. In such cases, paying the cash price directly can be more cost-effective than relying on insurance, as the administrative overhead and contract structures embedded in negotiated rates frequently inflate the final cost for the patient.
Patients should proactively contact the hospital to inquire about self-pay or prompt-pay discounts, which can reduce the bill by 20% to 50% when paid upfront. Although the facility is a voluntary non-profit Critical Access Hospital, the lack of a specific county average in the provided data means the state-level comparison remains the primary benchmark for evaluating pricing fairness. To ensure you are not overcharged, request an itemized billing audit before finalizing payment, as over 80% of hospital bills contain errors such as double-billing or unbundled codes. Additionally, be aware that while the No Surprises Act protects against balance billing for emergency care at in-network facilities, it is crucial to verify that all ancillary services, such as laboratory tests, are covered under the same network agreements to avoid unexpected out-of-pocket expenses.