Psychiatric evaluation (first visit)
Facility: Stanton County Hospital
Billing Code: 90791 (CPT)
- CPT Billing Code: 90791
- Insurance Median: $207
- Cash Discount Price: $242
- vs. Medicare Baseline: 1.14x 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 | $161 - $230 | 89% |
| Healthy Blue Mcaid | $207 | 114% |
| Healthy Blue Mcr Adv - All Other Plans | $238 | 131% |
Consumer Guidance & Cost Commentary
For the CPT code 90791, representing a psychiatric evaluation at Stanton County Hospital in Johnson, KS, the cash median price is $242.00, which matches the facility's gross charge. This rate is 110% of the Medicare benchmark of $181.34, indicating a markup of 10% above the federal cost baseline. While the facility is a government-owned Critical Access Hospital, patients with high-deductible plans may find paying the cash price directly more cost-effective than using insurance, as commercial negotiated rates often exceed cash prices due to administrative overhead. The data shows no specific negotiated rate provided in this report, but patients should verify their specific plan's allowed amount and inquire about self-pay or prompt-pay discounts before scheduling to ensure they are not paying the full gross charge.
Insurance payers for this service include Blue Cross Blue Shield, Healthy Blue Mcaid, and Healthy Blue Mcr Adv, with negotiated rates ranging from $161 to $238 depending on the specific plan. It is important to note that these negotiated rates are contractual ceilings set by insurers and do not necessarily represent the lowest possible price, as some in-network facilities charge significantly more than others. Patients should avoid assuming that being in-network guarantees the best price and should check their deductible status before relying on insurance coverage. If a balance bill arises from out-of-network ancillary services, the No Surprises Act may provide protection, but patients should request an itemized billing audit to identify any errors, unbundled codes, or services not rendered before finalizing payment.