Psychiatric evaluation (first visit)
Facility: Phillips County Hospital
Billing Code: 90791 (CPT)
- CPT Billing Code: 90791
- Insurance Median: $225
- Cash Discount Price: $196
- vs. Medicare Baseline: 1.24x 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 | $169 - $191 | 93% |
| UnitedHealthcare | $180 - $236 | 99% |
| Health Partners-All Plans | $225 - $236 | 124% |
| Medicaid / KanCare | $225 - $236 | 124% |
Consumer Guidance & Cost Commentary
For this psychiatric evaluation at Phillips County Hospital, the cash price of $196.00 is notably lower than the facility's negotiated rates, which range from $169 to $236 depending on the insurance carrier. While the median negotiated amount is $225.00, patients with high-deductible plans may find paying cash upfront more cost-effective, as the cash price avoids the administrative overhead and markup inherent in insurance billing cycles. It is important to note that this facility is a Critical Access Hospital in Phillipsburg, KS, and while specific county or state averages were not provided in the data, the cash rate remains a strong baseline for comparison against the higher commercial rates charged to insured members.
The Medicare benchmark for this service is $181.34, and the facility's cash price of $196.00 is slightly higher than the Medicare amount, reflecting the specific cost structure of this Critical Access Hospital. However, the gross charge of $231.00 represents a significant markup over the Medicare rate, illustrating why comparing commercial rates directly to the Medicare benchmark is essential for understanding true pricing. To secure the lowest possible cost, patients should explicitly request a "self-pay" or "prompt-pay" discount before scheduling, as these upfront payment incentives can reduce the final bill by 20% to 50% and bypass the complex claims processing that inflates insurance payments.