CMS Price Transparency Data

Psychiatric evaluation (first visit)

Facility: Shodair Children's Hospital

Billing Code: 90791 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 90791
Insurance Median: $166
Cash Discount Price: $273
vs. Medicare Baseline: 0.92x Medicare

The contracted insurance negotiated median rate for a Psychiatric evaluation (first visit) at Shodair Children's Hospital is $166. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $273. Compared to the federal Medicare reimbursement reference rate of $181.34, this hospital’s rate is 0.92x the Medicare baseline. Located in 2755 Colonial Dr, Helena, MT.

Cash / Self-Pay

$273

Average discount available for prompt cash payment at this facility.

Insurance Median

$166

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: $273 (151%)

Insurance Median: $166 (92%)

Cash: $273 (151% of Medicare)

Ins. Median: $166 (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
Tricare	$121	67%
Triwest - All Plans	$130	72%
Pacificsource - All Plans	$202	111%
Allegiance - All Plans	$204	112%

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 $273.
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 Shodair Children's 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.