Psychiatric evaluation (first visit)
Facility: Cloud County Health Center
Billing Code: 90791 (CPT)
- CPT Billing Code: 90791
- Insurance Median: $241
- Cash Discount Price: $180
- vs. Medicare Baseline: 1.33x 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 |
|---|---|---|
| Mpi-All Plans | $191 - $244 | 105% |
| Pponext-All Plans | $214 - $245 | 118% |
| Aetna | $231 - $239 | 127% |
| Health Partners - All Plans | $244 | 135% |
Consumer Guidance & Cost Commentary
For this psychiatric evaluation at Cloud County Health Center in Concordia, KS, the facility's cash price of $180.00 is lower than the state average of $244.00, making it a cost-effective option for patients paying out-of-pocket. While the median negotiated rate for in-network payers is $244.00, which is higher than the cash price, patients with high-deductible plans may find that paying the cash rate of $180.00 directly is more economical than relying on insurance, as the insurer's allowed amount often exceeds the cash price. It is important to note that while the facility is a Critical Access Hospital, patients should verify their specific plan details and ask about "self-pay" or "prompt-pay" discounts before scheduling, as these upfront payment incentives can further reduce the final cost.
The data indicates that Medicare sets a benchmark rate of $181.34 for this service, which serves as a reliable baseline for evaluating commercial pricing. The facility's cash rate of $180.00 is nearly identical to the Medicare amount, suggesting a fair pricing structure that avoids the common pitfall of comparing discounts against inflated chargemaster lists. If you are billed a higher amount by an out-of-network provider, you may be subject to balance billing for the difference between the provider's full charge and the insurance payment; however, the No Surprises Act protects patients from these surprise bills for emergency care and non-emergency services at in-network facilities. To ensure accuracy, always request a detailed, itemized bill before paying, as summary invoices can obscure errors or unbundled charges that should be reviewed with the billing department.