CMS Price Transparency Data

Psychiatric evaluation (first visit)

Facility: Essentia Health

Billing Code: 90791 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 90791
Insurance Median: $186
Cash Discount Price: $260
vs. Medicare Baseline: 1.03x Medicare

The contracted insurance negotiated median rate for a Psychiatric evaluation (first visit) at Essentia Health is $186. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $260. Compared to the federal Medicare reimbursement reference rate of $181.34, this hospital’s rate is 1.03x the Medicare baseline. Located in 3000 32Nd Ave South, Fargo, ND.

Cash / Self-Pay

$260

Average discount available for prompt cash payment at this facility.

Insurance Median

$186

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: $260 (143%)

Insurance Median: $186 (103%)

Cash: $260 (143% of Medicare)

Ins. Median: $186 (103% 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
Medica Access	$93	51%
Healthpartners Care Pmap	$135	74%
Sanford Health Plan	$149 - $285	82%
Primewest	$154	85%
Blue Cross Blue Shield	$156 - $364	86%
Advocare/Security Health	$161	89%
Freedom Blue Ppo	$161	89%
Healthpartners Care Msho / Mcr Adv	$161	89%
Imcare Msho Pcc Prime	$161	89%
Imcare Msho Ref Req	$161	89%
Itasca Med Care	$161	89%
Medica Advantage Solutions	$161	89%
Medica Msho/Dual Solutions	$161	89%
Medica Prime Solution Group	$161	89%
Medicare (plans)	$161	89%
Nd Va Administration	$161	89%
Platinum Blue/Vantage Blue	$161	89%
Primewest Msho	$161	89%
Secure Blue Msho	$161	89%
Ubh Cost Plan	$161	89%
Ubh Msho	$161	89%
Ucare Msho	$161	89%
UnitedHealthcare	$161 - $277	89%
Medica	$192 - $214	106%
Medica Uplan	$192	106%
Medica Choice	$220	121%
Ucare	$228	126%
Cigna	$232	128%
Healthpartners	$232	128%
Healthpartners Pcc Prime	$232	128%
Wea	$250 - $267	138%
America'S Ppo	$269	148%
Wps	$288 - $291	159%
Aetna	$295	163%

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 $260.
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 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.