CMS Price Transparency Data

Psychiatric evaluation (first visit)

Facility: Munson Healthcare Otsego Memorial Hospital

Billing Code: 90791 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 90791
Insurance Median: $192
Cash Discount Price: $272
vs. Medicare Baseline: 1.06x Medicare

The contracted insurance negotiated median rate for a Psychiatric evaluation (first visit) at Munson Healthcare Otsego Memorial Hospital is $192. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $272. Compared to the federal Medicare reimbursement reference rate of $181.34, this hospital’s rate is 1.06x the Medicare baseline. Located in 825 N Center Ave, Gaylord, MI.

Cash / Self-Pay

$272

Average discount available for prompt cash payment at this facility.

Insurance Median

$192

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$181.34

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $181.34 (100%)

Cash / Self-Pay: $272 (150%)

Insurance Median: $192 (106%)

Cash: $272 (150% of Medicare)

Ins. Median: $192 (106% of 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.

Billing Status

Remaining Deductible ($)

Your Coinsurance Rate (%)

Input your details and click calculate to compare out-of-pocket costs.

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	$92 - $200	51%
Mclaren Health Plan	$92 - $268	51%
Meridian	$92 - $94	51%
Molina	$92 - $191	51%
Priority Health	$92 - $253	51%
UnitedHealthcare	$92 - $256	51%
Blue Care Network	$137 - $177	76%
Hap (Health Alliance Plan)	$137 - $256	76%
Humana	$137 - $177	76%
Medicare (plans)	$137 - $177	76%
Michigan Amish Medical Board	$137 - $177	76%
Northern Michigan Mennonite Group	$137 - $177	76%
Aetna	$138 - $259	76%
Hospice Of Michigan	$192	106%
Cigna	$195 - $253	108%
Asr Physicians Care Network	$205 - $256	113%
Nomi Health	$219 - $256	121%
Munson Hospice	$224 - $852	124%
Employee Benefit Logistics	$232 - $301	128%
Enterprise Group Planning/Employee Benefit Plan	$256	141%
Cofinity	$272	150%
Provider Network Of America/Hawaii Mainland Administrative Group Health	$272	150%
Three Rivers Provider Network	$272	150%

Self-Pay Upfront Cash Action Plan

Request a "Self-Pay classification" with the billing desk before receiving care.
Ask for a written "Prompt-Pay Discount" agreement quoting the price of $272.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 90791.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Munson Healthcare Otsego Memorial Hospital is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 90791.
Confirm the specific physician or imaging center is also in-network (not just the hospital building).
Audit your Explanation of Benefits (EOB) against the final itemized hospital invoice.