Psychiatric evaluation (first visit)
Facility: Hospital District #6 Patterson Health Center
Billing Code: 90791 (CPT)
- CPT Billing Code: 90791
- Insurance Median: $180
- Cash Discount Price: $160
- vs. Medicare Baseline: 0.99x 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 | $159 - $168 | 88% |
| UnitedHealthcare | $180 - $200 | 99% |
| Providers Care (Wppa)-All Plans | $350 | 193% |
Consumer Guidance & Cost Commentary
For the CPT code 90791, representing a psychiatric evaluation at the Hospital District #6 Patterson Health Center in Anthony, KS, the facility's cash median price is $160.00, which is lower than the state average of $180.00. While the facility's negotiated rates with Blue Cross Blue Shield range from $159 to $168 and UnitedHealthcare from $180 to $200, these amounts are still higher than the cash price. This pricing structure highlights a common scenario where paying out-of-pocket can be more cost-effective for patients with high-deductible plans, as the insurance negotiated rates often exceed the cash price due to administrative overhead and contract dynamics.
To secure the best possible rate, patients should verify if the facility offers "self-pay" or "prompt-pay" discounts, which can reduce bills by 20% to 50% for upfront payment. It is important to note that the facility's negotiated rates are significantly higher than the Medicare benchmark of $181.34, indicating a markup typical of commercial contracts. Consumers are advised to request an itemized bill before scheduling to ensure no errors exist and to avoid balance billing, especially since the No Surprises Act protects against unexpected out-of-network charges at in-network facilities. Always confirm your deductible status and ask for a waiver of insurance submission if you intend to pay cash directly to bypass administrative fees.