Psychiatric evaluation (first visit)
Facility: Memorial Hospital
Billing Code: 90791 (CPT)
- CPT Billing Code: 90791
- Insurance Median: $141
- Cash Discount Price: $257
- vs. Medicare Baseline: 0.78x 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 | $41 | 23% |
| Humana | $128 | 71% |
| Tricare | $128 - $136 | 71% |
| Medicare (plans) | $130 | 72% |
| Ambetter / Centene | $141 - $150 | 78% |
| Coventry - All Other Plans | $231 | 127% |
| Preferred Healthcare-All Plans | $244 | 135% |
| Health Partners Of Kansas - All Plans | $244 | 135% |
| Wppa/Providers Care-All Plans | $359 | 198% |
Consumer Guidance & Cost Commentary
For a psychiatric evaluation at Memorial Hospital in Abilene, KS, the cash price is $257.00, which matches the facility's median negotiated rate of $192.00 and the Medicare benchmark of $181.34. While commercial payers like Blue Cross Blue Shield and Humana have negotiated rates of $41.00 and $128.00 respectively, these figures are significantly lower than the cash price, suggesting that for patients with high-deductible plans, paying the cash rate of $257.00 upfront might be more cost-effective than relying on insurance, as the insurer's allowed amount could exceed the cash price. It is important to note that while the facility is a Critical Access Hospital owned by a Government Hospital District, patients should verify their specific plan's allowed amount before scheduling, as commercial rates can vary widely; for instance, Wppa/Providers Care has a negotiated rate of $359.00, which is substantially higher than the cash price.
Patients should be aware that commercial negotiated rates often include administrative overhead and do not always represent the lowest possible cost, even for in-network services. If you choose to pay out-of-pocket, ask the hospital directly about "self-pay" or "prompt-pay" discounts, which can reduce the bill by 20% to 50% if paid in full within a short window, bypassing the costly insurance claims cycle. Furthermore, if you receive a bill from an out-of-network provider at this in-network facility, the No Surprises Act protects you from balance billing for emergency and non-emergency services, so you should never feel pressured to sign away your rights to dispute