CMS Price Transparency Data

Psychiatric evaluation (first visit)

Facility: Essentia Health Ada

Billing Code: 90791 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 90791
Insurance Median: $167
Cash Discount Price: $256
vs. Medicare Baseline: 0.92x Medicare

The contracted insurance negotiated median rate for a Psychiatric evaluation (first visit) at Essentia Health Ada is $167. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $256. Compared to the federal Medicare reimbursement reference rate of $181.34, this hospital’s rate is 0.92x the Medicare baseline. Located in 201 9Th Street West, Ada, MN.

Cash / Self-Pay

$256

Average discount available for prompt cash payment at this facility.

Insurance Median

$167

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: $256 (141%)

Insurance Median: $167 (92%)

Cash: $256 (141% of Medicare)

Ins. Median: $167 (92% 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
Healthpartners Care Pmap	$135	74%
Medica Access	$138	76%
Sanford Health Plan	$149 - $157	82%
Primewest	$154	85%
Itasca Med Care	$161	89%
Advocare/Security Health	$167	92%
Blue Cross Blue Shield	$167 - $302	92%
Freedom Blue Ppo	$167	92%
Healthpartners Care Msho / Mcr Adv	$167	92%
Imcare Msho Pcc Prime	$167	92%
Imcare Msho Ref Req	$167	92%
Medica Advantage Solutions	$167	92%
Medica Msho/Dual Solutions	$167	92%
Medica Prime Solution Group	$167	92%
Medicare (plans)	$167	92%
Nd Va Administration	$167	92%
Platinum Blue/Vantage Blue	$167	92%
Primewest Msho	$167	92%
Secure Blue Msho	$167	92%
Ubh Cost Plan	$167	92%
Ubh Msho	$167	92%
Ucare Msho	$167	92%
UnitedHealthcare	$167 - $314	92%
Healthpartners	$211 - $231	116%
Ucare	$228	126%
Cigna	$231	127%
Healthpartners Pcc Prime	$231	127%
Wea	$250 - $267	138%
America'S Ppo	$269	148%
Medica	$288 - $304	159%
Medica Uplan	$288	159%
Wps	$291	160%
Aetna	$295	163%
Blue Plus Pmap Pcc Prime	$302	167%
Medica Choice	$313	173%

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 $256.
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 Essentia Health Ada 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.