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CMS Price Transparency Data Hospital file updated: 2026-03-04

Psychiatric evaluation (first visit)

Facility: Sanford Wheaton Medical Center

Billing Code: 90791 (CPT)

Pillar 1 · The BaseRate™ CompositeHow 1.00× Fair BaseRate Works: Raw price averages unfairly penalize hospitals in high-wage cities or trauma centers treating sicker patients. We adjust for local CMS hospital wage levels and patient complexity first. A 1.00× score means right at the fair price average, 0.85× means 15% cheaper than fair market, and 1.30× means 30% above fair market.Good Deal · Below Fair Market
$186Fair BaseRate (0.91× Market)
Position vs. 1.00× Fair Price9% Below Fair Price 1.00× (center of the bar) is the U.S. fair price average after accounting for local hospital wages and patient complexity. Left of center (<1.00×) is below fair price; right of center (>1.00×) is above fair price.

This hospital's typical commercial price is $169 compared to the $186 fair price benchmark.

Pillar 2 · VeriRate™ Data TrustHow VeriRate™ (0–100) Works: Hospitals are legally required to publish machine-readable price files, but some bury fake $0.01 numbers or omit cash discounts. VeriRate audits each file across 5 checks (hover any badge below to see what it tests).86/100 · Verified
86/100Hover Any Check Below to See How Prices Were Audited
File Completeness90Provenance (File Completeness): Checks whether the hospital published a complete, up-to-date machine-readable price file with valid CPT and MS-DRG billing codes instead of leaving blanks.
Price Logic88Coherence (Price Logic): Checks whether the hospital’s numbers make basic sense — e.g., self-pay cash price is lower than gross list price, with no fake $0.01 or $999,999 placeholder numbers.
Peer Alignment86Concordance (Peer Alignment): Checks whether reported prices sit in a realistic range compared to Medicare and nearby hospitals rather than wild 100× unit errors.
Clean Billing83Regularity (Clean Billing): Checks whether rates are structured consistently across procedures without erratic statistical spikes or hidden unbundled facility fees.
Real Cash Discount84Cash Honesty (Real Cash Discount): Checks whether the hospital offers a genuine self-pay cash discount that beats or matches commercial insurance rates instead of billing full sticker price.
Pillar 3 · Clinical Quality & ER SpeedChecks whether higher hospital prices actually buy better clinical quality — combining CMS Star Ratings, hospital safety scores, and emergency room wait times.Regional Value Leader
CMS Star RatingNot RatedOfficial CMS Overall Hospital Quality Star Rating (1 to 5 stars) summarizing mortality, safety of care, readmissions, and patient experience.
Safety ScoreNot ScoredComposite patient safety score (0–100) derived from CMS hospital-acquired infection rates (CLABSI, CAUTI, MRSA, C. diff), surgical complications, and HCAHPS surveys.
Typical ER WaitNo ER DataMedian minutes patients spent in the emergency department before leaving from the visit, as reported to CMS Timely and Effective Care.

Balances commercial hospital prices against CMS clinical safety, infection control, and patient experience.

The BaseRate · fair price high confidence
A fair price for this
$186
about 1.0× the $181 Medicare rate · typically $134–$338
modeled estimate · not a bill or quote
What this hospital charges insurers
$169
About the fair price
about $17 under the fair price · 0.9× Medicare
Medicare pays $181 Fair price $186 This hospital $169 Cash price $333 Hospital's list price $416

How we calculate the fair BaseRate →

How this hospital compares to other MN hospitals

Highest price of the 9 MN hospitals we have prices for — worth calling around.

Cheapest $141 Priciest $169

Black dot = this hospital, among the 9 MN hospitals with a price for this procedure. Full list below.

A fair price for a Psychiatric evaluation (first visit) is about $186 (about 1.0× the $181 Medicare rate). Sanford Wheaton Medical Center charges insurers about $169, or about $333 in cash — about the fair price. Located in Wheaton, MN.

What each insurance company pays

Which insurers have negotiated a price with this hospital for this procedure — and which haven’t.

3 of 6 major insurers have a published price at this hospital

UnitedHealthcareBlue Cross Blue ShieldAetna CignaHumanaKaiser Permanente

Crossed out = this hospital hasn’t published a negotiated price for that insurer for this procedure. It doesn’t necessarily mean they aren’t accepted — ask your insurer.

Insurance company Price range vs. Medicare
UnitedHealthcaremajor $227 - $347 125%
Blue Cross Blue Shieldmajor $101 - $385 56%
Aetnamajor $227 - $362 125%
Health Net $374 206%
HealthPartners $227 - $337 125%
Medica $366 - $394 202%
Sanford Health Plan $210 - $386 116%
Security Health Plan $229 126%
UCare $169 - $366 93%
+ 2 smaller / regional plans $232 - $374
Government programs also on file: Medicare.
Excludes 1 rental-network / third-party entry (e.g. Multiplan, PHCS) — these are pricing networks, not insurers.

Self-Pay How to get the cash price

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Facility Profile & Credentials

  • Address: 401 12Th Street North, Wheaton, MN 56296
  • CMS Rating: No CMS Rating
  • Ownership Type: Voluntary non-profit - Private
  • Hospital Type: Critical Access Hospitals

Other Procedures at Sanford Wheaton Medical Center

Compare: Psychiatric evaluation (first visit) at other MN hospitals

Insurance negotiated median for the same procedure, sorted lowest first.

Inline Bill X-Ray & 501(r) Calculator 501(c)(3) Nonprofit · Free Care ≤200% FPL · AGB Cap 36.3%

Audit a Bill or Quote at Sanford Wheaton Medical Center (Zero PHI Required)

CMS CCN: 241304
CPT 90791
Fair BaseRate™ $186
Medicare Rate $181
Self-Pay Cash $333
Insurer Median $169
Pre-filled with Sanford Wheaton Medical Center’s charged/list benchmark
Screened against 2026 HHS Federal Poverty Guidelines
2026 FPL: $15,650 + $5,500 per additional person
Step 1 · 501(r) Charity Care Check 501(r) AGB Cap: $151 (274% FPL)

Statutory 501(r) AGB Cap Limits Bill to $151

At 274% FPL (201%–400% FPL tier), 26 U.S.C. § 501(r)(5) caps FAP-eligible bills at Amounts Generally Billed (36.3% of gross = $151).

Step 2 · Cash vs. Insurance Arbitrage Save $83 Paying Cash

Self-Pay Cash Rate ($333) Beats Your Bill

Sanford Wheaton Medical Center's published 45 CFR § 180 self-pay cash rate is $333 (vs. $169 commercial insurer median). Ask billing to reclassify the visit to prompt-pay self-pay if it beats your deductible.

Step 3 · Fair BaseRate Target +$230 Above Fair BaseRate

Negotiate Toward $186 Fair BaseRate ($181 Medicare)

Your bill ($416) is $230 above the denoised Fair BaseRate ($186) and 2.3× the $181 Medicare rate.

1-Click Factual Dispute Summary: Copy a citation-backed benchmark memo (with CMS CCN, CPT code, Medicare reference, Fair BaseRate, and 26 U.S.C. § 501(r) calculations) to paste into patient-portal messages or billing appeals.
Care-Setting Arbitrage, Bilateral SVD Insurer Leverage & Regional Alternatives

How to Pay Less Nearby: Freestanding Centers, Insurer Leverage & Outpatient Savings

45 CFR § 180 Primary-Source Lineage & Federal Verification Verified CMS CCN 241304

Verify the Raw Data: Official Hospital MRF, CMS Medicare.gov & Federal Filings

MRF Portal Indexed (450409348_sanford-wheaton_standardcharges.csv) Verify on CMS Medicare.gov (CCN 241304) ↗ CMS HCRIS Cost Reports ↗
Published MRF File450409348_sanford-wheaton_standardcharges.csv
Publication / Vintage2026-03-04 · 49.96 MB
Validated Rate Rows637,140 (CMS v3.0.0)
File Integrity Digest934c06d0d9ef32faad57…

Safe-Harbor Data Corrections: Parsed directly from public 45 CFR § 180 hospital filings, CMS Care Compare, and CMS HCRIS cost reports. Hospital compliance officers may submit updated MRF URLs or rate tables for verification.

Submit MRF Update Correction Policy