CMS Price Transparency Data

Psychiatric evaluation (first visit)

Facility: The McDowell Hospital

Billing Code: 90791 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 90791
Insurance Median: $215
Cash Discount Price: $525
vs. Medicare Baseline: 1.19x Medicare

The contracted insurance negotiated median rate for a Psychiatric evaluation (first visit) at The McDowell Hospital is $215. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $525. Compared to the federal Medicare reimbursement reference rate of $181.34, this hospital’s rate is 1.19x the Medicare baseline. Located in 430 Rankin Drive P O Box 730, Marion, NC.

Cash / Self-Pay

$525

Average discount available for prompt cash payment at this facility.

Insurance Median

$215

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: $525 (290%)

Insurance Median: $215 (119%)

Cash: $525 (290% of Medicare)

Ins. Median: $215 (119% 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
Blue Cross Blue Shield	$56 - $247	31%
United	$57 - $321	31%
Wellcare	$58 - $86	32%
Amerihealth	$59 - $87	33%
Partners Health Management	$59 - $87	33%
Vaya Health	$59 - $87	33%
Apex Health	$85 - $125	47%
Cigna	$145 - $335	80%
Aetna	$156 - $452	86%
Oscar	$184 - $271	101%
Caresource	$186 - $275	103%
Medcost	$188 - $532	104%
Amerihealth Caritas	$199 - $294	110%
Magellan	$254	140%
Magellan Behavioral Health	$254	140%
Multiplan	$339 - $500	187%
Avalon Administrative Services	$360 - $532	199%
Prime Health	$373 - $563	206%

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 $525.
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 The McDowell 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.