CMS Price Transparency Data

Psychiatric evaluation (first visit)

Facility: Hermann Area District Hospital

Billing Code: 90791 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 90791
Insurance Median: $179
Cash Discount Price: $178
vs. Medicare Baseline: 0.99x Medicare

The contracted insurance negotiated median rate for a Psychiatric evaluation (first visit) at Hermann Area District Hospital is $179. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $178. Compared to the federal Medicare reimbursement reference rate of $181.34, this hospital’s rate is 0.99x the Medicare baseline. Located in 509 W 18Th St, Hermann, MO.

Cash / Self-Pay

$178

Average discount available for prompt cash payment at this facility.

Insurance Median

$179

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: $178 (98%)

Insurance Median: $179 (99%)

Cash: $178 (98% of Medicare)

Ins. Median: $179 (99% 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
UnitedHealthcare	$98 - $195	54%
Tricare	$100 - $135	55%
Choicecare Mcr Adv- All Plans	$106 - $143	58%
American Hlth Mcr Adv- All Plans	$111 - $150	61%
Blue Cross Blue Shield	$111 - $278	61%
Humana	$111 - $150	61%
Aetna	$113 - $324	62%
Wellcare Mcr Adv - All Plans	$113 - $153	62%
Harmony Hp Mcaid- All Plans	$146 - $198	81%
Cigna	$150 - $203	83%
Care Partners Mcaid- All Plans	$152 - $205	84%
Healthcare Usa Mcaid- All Plans	$164 - $222	90%
Healthlink Hmo	$164 - $222	90%
Ambetter / Centene	$178 - $240	98%
Healthy Blue Mcaid - All Plans	$181	100%
Healthlink Ppo - All Other Plans	$189 - $256	104%
Multiplan/Phcs - All Plans	$189 - $256	104%
Coventry - All Plans	$215 - $290	119%
Comp Results - All Plans	$227 - $307	125%
Three Rivers - All Plans	$227 - $307	125%

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 $178.
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 Hermann Area District 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.