Psychiatric evaluation (first visit)
Facility: Wilson Medical Center
Billing Code: 90791 (CPT)
- CPT Billing Code: 90791
- Insurance Median: $200
- Cash Discount Price: $188
- vs. Medicare Baseline: 1.10x 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 |
|---|---|---|
| Tricare | $132 | 73% |
| Humana | $132 | 73% |
| UnitedHealthcare | $132 - $232 | 73% |
| Aetna | $132 - $250 | 73% |
| Ambetter / Centene | $132 - $250 | 73% |
| Blue Cross Blue Shield | $168 - $250 | 93% |
| Cigna | $200 | 110% |
| Mulitplan-All Plans | $230 | 127% |
| Health Partners-All Plans | $230 | 127% |
Consumer Guidance & Cost Commentary
For this psychiatric evaluation at Wilson Medical Center in Neodesha, KS, the facility's cash price of $188 is lower than the gross charge of $250, offering a potential savings for patients with high-deductible plans. While the facility is a Critical Access Hospital owned by the local government, the negotiated rates vary significantly among payers; for instance, Tricare and Humana pay exactly $132, whereas UnitedHealthcare and Aetna have negotiated ranges extending up to $250. It is important to note that the median negotiated rate across all payers is $200, which is higher than the cash price. Patients should verify their specific plan's allowed amount before scheduling, as some insurers may pay less than the cash rate, making upfront payment the most cost-effective option.
The facility's pricing aligns closely with the Medicare benchmark of $181.34, with a ratio of 1.1 times the Medicare amount, indicating a fair markup relative to federal standards. Although the data does not provide specific county or state average comparisons for this code, the cash price of $188 remains competitive against the commercial negotiated rates observed for major carriers like Cigna ($200) and Mulitplan-All Plans ($230). To maximize savings, patients should request a prompt-pay discount before check-in, which can reduce the bill by 20% to 50% if paid in full within 30 days. Additionally, if a patient receives an itemized bill, they should review it for any unbundled codes or services not rendered, as over 80% of hospital bills contain errors that can be corrected through a formal written