CMS Price Transparency Data

Psychiatric evaluation (first visit)

Facility: Wakemed, Raleigh Campus

Billing Code: 90791 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 90791
Insurance Median: $365
Cash Discount Price: $308
vs. Medicare Baseline: 2.01x Medicare

The contracted insurance negotiated median rate for a Psychiatric evaluation (first visit) at Wakemed, Raleigh Campus is $365. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $308. Compared to the federal Medicare reimbursement reference rate of $181.34, this hospital’s rate is 2.01x the Medicare baseline. Located in 3000 New Bern Ave, Raleigh, NC.

Cash / Self-Pay

$308

Average discount available for prompt cash payment at this facility.

Insurance Median

$365

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: $308 (170%)

Insurance Median: $365 (201%)

Cash: $308 (170% of Medicare)

Ins. Median: $365 (201% 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.

Elevated Commercial Rate Alert (Value-Gap)

The negotiated rate at this facility is 201% of the Medicare baseline (a markup of 101%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Consult Patient Advocate

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	$119 - $404	66%
Amerihealth	$145	80%
Carolina Complete	$145	80%
Wellcare	$145 - $155	80%
Aetna	$155 - $551	85%
Liberty	$158	87%
Pruitt	$158	87%
Alignment	$163	90%
Cigna	$238 - $414	131%
Ambetter / Centene	$250 - $294	138%
First Health	$373 - $714	206%
Medcost	$584 - $608	322%
Phcs	$649	358%
Multiplan	$730	403%

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 $308.
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 Wakemed, Raleigh Campus 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.