Psychiatric evaluation (first visit)
Facility: Clay County Medical Center
Billing Code: 90791 (CPT)
- CPT Billing Code: 90791
- Insurance Median: $266
- Cash Discount Price: $280
- vs. Medicare Baseline: 1.47x 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 |
|---|---|---|
| Wppa/Providrs Care- All Plans | $261 | 144% |
| Aetna | $261 | 144% |
| Health Partners - All Plans | $266 | 147% |
| UnitedHealthcare | $266 | 147% |
| Multiplan- All Plans | $266 | 147% |
Consumer Guidance & Cost Commentary
For this psychiatric evaluation at Clay County Medical Center in Clay Center, KS, the cash price is $280.00, which matches the facility's median negotiated rate of $266.00 and the cash median. While the gross charge listed is $280.00, patients should be aware that paying out-of-pocket directly can sometimes be more cost-effective than using insurance if their plan's negotiated rate exceeds the cash price. Since this facility is a Critical Access Hospital with government-local ownership, patients are encouraged to explicitly ask about "self-pay" or "prompt-pay" discounts before scheduling to ensure they receive the lowest possible rate.
The Medicare benchmark for this service is $181.34, which serves as a baseline for evaluating the facility's pricing markup. Although the data does not provide specific state or county average comparisons for this code, the facility's negotiated rate of $266.00 represents the amount an in-network insurer would typically pay. Patients should avoid accepting summary bills and instead request a full itemized statement to verify that no unbundled codes or services not rendered are included. If any balance billing occurs, such as unexpected charges from out-of-network ancillary services, patients can dispute the bill with their insurer under the No Surprises Act to prevent unexpected costs.